Orbital Cellulitis in Adults: Causes, Symptoms, Diagnosis, Treatment

Orbital Cellulitis, also named, Postseptal Cellulitis and, on occasion, misdiagnosed as Periorbital Cellulitis. The former can have life-changing implications for eye health, the latter is not quite so problematical. Orbital Cellulitis is medically defined as inflammation – any medical phrase or name with the suffix, ‘itis’, denotes inflamed tissue – of the delicate structures located to the posterior of the orbital septum, in layman’s terms, the eye socket.

What is the orbit of the eye?

Scientifically, the orbit is the cavern in the human skull where the eyeball sits. Orbit indicates this bony chamber and also refers to the actual soft tissue assembly of the eye itself. A total of seven bones comprise the recess.

The moniker, ‘orbital’ in conjunction with a reference to disease, describes any compromise be it traumatic or clinical disorder to either the aperture or its contents.

How do you catch or contract orbital cellulitis?

Habitually, orbital cellulitis is an imported infection from either nearby so, the front of the eye or eyelid, the sinuses or dental disease or, further afield, transported to this destination via the bloodstream and circulation. Statistics demonstrate that approximately 90% of those with orbital cellulitis also have sinusitis. A relatively uncommon illness, orbital cellulitis is more routinely diagnosed in children where multiple causes are generated from minor injuries, superficial eye problems and upper respiratory tract infections. But, it can appear in adults.

Is orbital cellulitis life threatening?

Orbital cellulitis is a red flag for embedded systemic infection which, if allowed to progress unchecked, will ultimately threaten life. If left unmanaged for a period of time, it can permanently damage the sufferer’s vision. Pre the advent of antibiotics, loss of sight was a much feared and not unheard of outcome with orbital cellulitis.

What are the defining symptoms of orbital cellulitis?

The main distinction between orbital cellulitis and periorbital cellulitis is that inflammation occurs in the eye socket shoving the eye forward. This protuberance is pronounced ‘proptosis’. The eye becomes displaced disrupting the delicate placement and mechanics. Pain may be felt when moving or rolling the eye, vision may change or diminish and the eyelid can swell sufficiently for the eye to struggle to open. There are accompanying discharge or exudates. Additional to these symptoms of orbital cellulitis, the underlying infection may start to cause systemic problems leading to headache, vomiting, fever, loss of appetite and exhaustion. What is crucial is that immediate and urgent help from an ophthalmologist is sought to combat the basal bacteria and protect the eye from damage. A picture is worth a thousand words, some of these pictures and images will define this condition far better than a generalised description which could equally apply to less serious disorders, hence the possibility of confusion and misdiagnosis.

What is the treatment for orbital cellulitis?

Heavy duty antibiotics administered intravenously – Cefotaxime and Flucloxacillin – so hospitalisation is required. A broad spectrum cocktail of drugs is utilised as the bacteria is not likely to be unusual, merely entrenched and rapidly multiplying. Close monitoring is essential of optical function to ensure the patient responds well to the medication and the situation does not worsen. Surgical intervention may be an option if there are pockets of infection which can be manually cleared or if the antibiotics are not getting on top of the progression. Surgery can relieve abscesses which may have developed in the eye socket or cavities within the brain and reduce pressure build up by draining excess fluid. If the infection is stubbornly persistent then samples may be taken for culture and further investigation.

Whatever the treatment recommended for orbital cellulitis, it must be aggressive and under complete medical supervision for the duration of the illness.

Can orbital cellulitis develop complications?

Uncontrolled, orbital cellulitis can leave the patient with life-changing disabilities such as damaged vision or hearing and potentially sepsis or meningitis both of which are seriously life endangering.

Is orbital cellulitis contagious?

Whilst some superficial eye infections are very contagious, orbital cellulitis is not usually transmitted between different people via the medium of contact.

What is the average recovery time after treatment for orbital cellulitis?

With a fair wind and no unexpected complications, the IV medicines are usually in place for one or two weeks.

If fever is absent and there are no other systemic concerns, patients may be discharged commonly with oral medication for a further two to three weeks giving a total recovery time for a straightforward case of orbital cellulitis of between 4-6 weeks.

Why is orbital cellulitis less common in adults?

If you consider the predisposing factors that can create an environment for orbital cellulitis to flourish then the local play group or pre-school hits that nail right on the head. Almost constant respiratory infections, recurrent outbreaks of conjunctivitis, juvenile lack of awareness plus poor hygiene and close proximity and you have the perfect recipe for orbital cellulitis. Orbital cellulitis does present in adults, just less frequently. A mature immune response is a key advocate in fighting the infection so youth brings with it its own vulnerability and challenges.

 

 

Article References:

  1. https://teachmeanatomy.info/head/organs/eye/bony-orbit/
  2. http://www.bbc.co.uk/newsbeat/article/34866829/life-before-antibiotics-and-maybe-life-after-an-antibiotic-apocalypse
  3. https://www.drugbank.ca/drugs/DB00493
  4. https://www.medicalnewstoday.com/articles/324460.php
  5. https://www.mayoclinic.org/diseases-conditions/cellulitis/expert-answers/cellulitis/faq-20058458
  6. https://patient.info/doctor/orbital-and-preseptal-cellulitis

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