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Orbital cellulitis: pathophysiology
Orbital cellulitis usually occurs as a result of:
Extension of an infection from the periorbital structures (usually the paranasal sinuses, especially ethmoid sinusitis) and also from the face, the globe, the lacrimal sac and dental infection (via an intermediary maxillary sinusitis).
Occasionally, it may occur as an extension of preseptal cellulitis, particularly in young children in whom the orbital septum is not fully developed.
Direct inoculation of the orbit from trauma (accidental or surgical - including orbital, lacrimal, strabismus and vitreo-retinal surgery). Post-traumatic orbital cellulitis tends to develop within 72 hours of the injury.
Haematogenous spread from distant bacteraemia.The pathogens most commonly involved are the aerobic, non-spore-forming bacteria -Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes andHaemophilus influenzae (the latter mainly found in children).
Mucormycosis associated with patients who have diabetic ketoacidosis or
immunosuppression is also described. This very rare and rapidly spreading
infection caused by fungi, is aggressive and often fatal.
There has recently been an emergence of Meticillin-resistant S. aureus (MRSA) in the organisms isolated; this is rare but the development is
worrying. Orbital cellulitis may be complicated by spread to adjacent structures
and to the central nervous system.
Orbital cellulitis: Sudden onset of unilateral swelling of conjunctiva and lids. Proptosis (bulging of the eye). Pain with movement of the eye, restriction of eye movements. Blurred vision, reduced visual acuity, diplopia. Pupil reactions may be abnormal - relative afferent pupillary defect
(RAPD); see the separate article on Examination of the Eye. Fever, severe malaise.
Diagnosis is usually made based on the clinical findings and investigations are aimed at identifying the root cause of the infection - particularly in the case of orbital cellulitis. Investigations are carried out in the hospital setting.
FBC frequently shows a leukocytosis (>15 X109) but blood cultures are frequently negative in adults. They cannot be counted on to differentiate between preseptal and orbital cellulitis.
Any discharge from skin breaks should be swabbed and sent to microbiology. Throat swabs and samples of nasal secretions may also help diagnosis.
CT of the sinuses as well as the orbit ± brain: CT is usually indicated only for children (unless the child is
very well and the episode is mild) or if orbital cellulitis is suspected in an adult.
if an intracranial abscess is suspected, CT is the gold standard imaging modality, carried out to identify any subperiosteal abscesses, paranasal sinusitis or cavernous sinus thrombosis (all needing multi-speciality input).
It is also valuable in assessing trauma where there may be concerns about a retained orbital or intraocular foreign body.
MRI may complement the CT in diagnosing a cavernous sinus thrombosis.
If cerebral or meningeal signs develop, the patient may need a lumbar puncture. However a lumbar puncture is contra-indicated for suspected orbital cellulitis until a CT scan has ruled out raised intracranial pressure.
Orbital cellulitis Hospital admission under the joint care of the ophthalmologists and
the ENT surgeons is mandatory. Intravenous antibiotics are used (eg, cefotaxime and flucloxacillin)
in addition to metronidazole in patients over 10 years old with chronic sinonasal disease.
Clindamycin plus a quinolone such as ciprofloxacin are used where there is penicillin sensitivity. Vancomycin is also an alternative.
Optic nerve function is monitored every four hours (pupillary reactions, visual acuity, colour vision and light brightness appreciation).
Treatment may be modified according to microbiology results and lasts for 7-10 days.
Surgery is indicated where there is CT evidence of an orbital collection, where there is no response to antibiotic treatment, where visual acuity decreases and where there is an atypical picture which may warrant a diagnostic biopsy. Surgery often concurrently warrants drainage of infected sinuses.
Ocular: exposure keratopathy (which can lead to visual loss through permanent damage to the cornea), raised intraocular pressure, central retinal artery or vein occlusion, endophthalmitis, optic neuropathy.
Orbital abscess: more often associated with post-traumatic orbital cellulitis. Blindness can occur through direct extension of the infection to the optic nerve.
Subperiosteal abscess: usually located along the medial orbital wall. This may progress intracranially.
Intracranial (rare): meningitis, brain abscess, cavernous sinus thrombosis.
Early recognition and appropriate treatment should carry a good prognosis,
particularly in the absence of complications. However immunosuppressed individuals
are more susceptible to complications and fungal cellulitis can be associated with a
high rate of mortality.
What is it?Orbital cellulitis is a bacterial infection of the periocular tissues. Cellulitis restricted to the soft tissues anterior to the orbital septum (a connective tissue curtain that divides the anterior third from the posterior two thirds of the orbit) is called "pre-septal cellulitis." It is much less serious than infection that extends behind the orbital septum, called "post-septal cellulitis."
The infection usually starts in the paranasal sinuses, especially the ethmoid. It is especially common in children.
Orbital cellulitis is rare in adults, except among the immunocompromised—diabetes mellitus, chronic immunosuppressive agents, or irradiation. In these patients, the big danger is fungal infection—mucormycosis or aspergillosis. Both are life-threatening fungal infections that require prompt management.
How does it present?Orbital cellulitis presents with periocular pain, violaceous swelling of upper and lower lids, and mild, diffuse conjunctival hyperemia. Fever and upper respiratory infection symptoms may be present in children. The eyelids and globe are tender to the touch. If the infection extends posterior to the orbital septum, there will be reduced ocular movement and proptosis. Visual loss is rare.
In adults, fungal orbital infection originates more posteriorly in the orbit and may show minimal swelling. Ptosis, reduced eye movement, and vision loss are more common.
Delayed treatment can lead to blindness and intracranial spread of infection with meningitis, stroke, and death.
What to do?Order sino-orbital imaging studies to rule out sinusitis, orbital subperiosteal abscess, or tumor. Treat with intravenous antibiotics. Subperiosteal abscess may require surgical drainage.
Lack of improvement in 24 to 48 hours signals either an incorrect diagnosis or ineffective antibacterial agents.
Always think of fungal infections in immunocompromised hosts!
Orbital cellulitis is an acute infection of the tissues immediately surrounding the eye, including the eyelids, eyebrow, and cheek.
NEWS & FEATURES For a Teenage Boy, a Basketball and a Bug Spell Trouble
REFERENCE FROM A.D.A.M.
Back to TopCauses
Orbital cellulitis is a dangerous infection with potentially serious complications.
Bacteria from a sinus infection (often Haemophilus influenzae)usually cause this condition in children. Orbital cellulitis due to this bacteria used to be much more common in young children up to age 6 - 7.
However, such infection is now rare because of the HiB (Haemophilus influenzae B) vaccine.
The bacteria Staphylococcus aureus , Streptococcus pneumoniae , and beta-hemolytic streptococci may also cause orbital cellulitis.
Orbital cellulitis infections in children may get worse very quickly and can lead to blindness. Immediate medical attention is needed.
Back to TopSymptoms
Symptoms of orbital cellulitis may include:
Painful swelling of upper and lower eyelid, and possibly the eyebrow and cheek
Bulging eyes Decreased vision Eye pain , especially when moving the eye Fever, generally 102 degrees F or higher General ill feeling Painful or difficult eye movements Shiny, red or purple eyelid
Back to TopExams and Tests
Tests commonly include:
CBC (complete blood count) Blood culture Spinal tap in extremely sick children
Other tests may include:
X-ray of the sinuses and surrounding area CT scan or MRI of the sinuses and orbit Culture of eye and nose drainage Throat culture
Back to TopTreatment
The patient usually needs to stay in the hospital. Treatment includes antibiotics given through a vein. Surgery may be needed to drain the abscess, or relieve pressure in the orbital space around and behind the eye.
An orbital cellulitis infection can get worse very quickly. The patient must be carefully checked every few hours.
Back to TopOutlook (Prognosis)
With prompt treatment, the person can make a complete recovery.
Back to TopPossible Complications
Cavernous sinus thrombosis Hearing loss Septicemia or blood infection Meningitis Optic nerve damage and loss of vision
Back to TopWhen to Contact a Medical Professional
Orbital cellulitis is an emergency that requires immediate treatment. Call your health care provider if there are signs of eyelid swelling, especially with a fever.
Back to TopPrevention
Receiving the HiB vaccine according to recommended schedules generally will prevent most haemophilus infections in children. Young children in the same household who have been exposed to this bacteria may receive antibiotics to prevent getting sick.
Proper detection and early treatment of sinus, dental, or other infections may prevent the spread of infection to the eyes.
Orbital cellulitis is a relatively uncommon infective process involving
ocular adnexal structures posterior to the orbital septum.1 Inflammation
anterior to the orbital septum or preseptal cellulitis is common in young
children. It rarely involves postseptal anatomy, and physical examination
reveals eyelid edema in the absence of orbital signs such as gaze
restriction and proptosis.2 Orbital cellulitis is a condition that rarely
causes complete loss of vision if treated in a timely fashion. A history of
upper respiratory tract infection prior to the onset is very common
especially in children. For simplification, Chandler et al.3has classified
the disease into five categories and emphasized the possibility of fatality
due to cavernous sinus thrombosis and intracranial abscess. Despite
advances in antimicrobial therapy and surgical methods, intracranial
abscess remains a challenging problem and the mortality rate can be as
high as 40%.4 In the past, orbital cellulitis has been associated with a
number of serious complications including loss of visual acuity,
cavernous sinus thrombosis, meningitis, frontal abscess and
osteomyelitis, and even death.1,5 Since the advent of effective antibiotic
treatment, these serious complications have become much less frequent.
Prior to the availability of antibiotics, blindness was a relatively common
complication of orbital cellulitis, reported in approximately 20% of
cases.6 Case reports of blindness following bacterial orbital cellulitis in
the postantibiotic era are rare. For example, Connel et al.,7reported a
case of a 69-year-old male who presented with fulminant onset of
proptosis, significant ophthalmoplegia and no light perception. Despite
emergent drainage of an orbital abscess and aggressive intravenous
antibiotic therapy, there was no improvement in vision; although ocular
motility returned to normal.7 The mechanism of vision loss in Connel et
al.7 case remained unknown. The authors postulated streptococcal-
related ischemic necrosis of the posterior aspect of the optic nerve as a
possible mechanism of vision loss. In a recent survey of 52 patients with
orbital cellulitis, 18 (35%) presented with decreased visual acuity;
however, with long-term follow-up, only two (4%) patients had decreased
The most common predisposing factor for orbital cellulitis is sinus
disease, particularly in the younger age groups.1,5 The infection most
commonly originates from sinuses [Figure 2], eyelids, face, dental
abscess, retained foreign bodies, or distant soources by hematogenous
spread.1,5,9–11 Chandler et al.3has grouped complications of sinusitis into
five classes. In group 1, the eyelids are swollen with the presence of
orbital content edema (preseptal cellulitis). The swelling reflects an
impedance to drainage through ethmoid vessels. Venous congestion is
transmitted through the valveless veins to the eyelids and through the
superior ophthalmic vein to the orbit. In group II (orbital cellulitis), there
is a diffuse infiltration of orbital tissues with inflammatory cells. The
eyelids may be swollen and there may be conjunctival chemosis with
variable degree of proptosis and visual loss. In group III (subperiosteal
abscess), purulent material collects periorbitally and in the bony walls of
the orbit. There is pronounced eyelid edema, conjunctival chemosis, and
tenderness along the affected orbital rim with variable degree of motility,
proptosis, and visual acuity changes depending on the size and location
of the abscess. In group IV (orbital abscess), there is a collection of pus
inside or outside the muscle cone due to progressive and untreated
orbital cellulitis. Proptosis, conjunctival chemosis, decreased ocular
motility, and visual loss may be severe in these cases. In group V
(cavernous sinus thrombosis), there is an extension of orbital infection
into the cavernous sinus that can lead to bilateral marked eyelid edema
and involvement of the third, fifth, and sixth cranial nerves. There may be
associated generalized sepsis, nausea, vomiting, and signs of altered
mentation. An orbital apex syndrome, characterized by proptosis, eyelid
edema, optic neuritis, ophthalmoplegia, and neuralgia of the ophthalmic
division of the fifth cranial nerve is caused by sinus disease around the
optic foramen and superior orbital fissure
The outcomes from one of the largest series of orbital cellulitis from a developing country confirms previous observations from Western countries in which sinus infection has been implicated as the cause of orbital cellulitis in most of the reported cases.1 Specifically in the pediatric population, up to 90% of patients with orbital cellulitis had existing sinusitis, with almost half having multiple sinus involvement. Unlike patients in Western countries, most patients with sinusitis and orbital cellulitis sought treatment later in the course of their disease in this study. After sinusitis, periocular trauma and history of ocular or periocular surgery were the cause of a significant number of cases of orbital cellulitis among these patients, compared with the studies of orbital cellulitis from Western countries.5,8 Less commonly reported causes of orbital cellulitis, such as dacryocystitis, dental infection, and endophthalmitis also were found among these patients [Figure 3]. Sinusitis may also produce osteomyelitis and intracranial abscess. Osteomyelitis, commonly involving the frontal bone, is a direct extension of frontal infection or septic thrombophlebitis via the valveless sinus of Breschet.13 Osteomyelitis is rare in the ethmoids because from this location, infection can rapidly spread through the thin lamina papyracea into the orbit or maxilla, where arterial anastomoses are sufficient to prevent necrosis due to septic thrombosis of a single artery. Although meningitis is the most common intracranial complication of sinus disease, epidural, subdural, and brain parenchymal abscess can also occur.13
Although ultrasonography (U/S) can be useful as an in-office screening
procedure in cases of suspected orbital abscesses, CT-scan is necessary
to assess the sinuses and intracranial extension. On orbital U/S, orbital
abscess may show low internal reflectivity. On CT-scan, one may see a
localized, generally homogenous elevation of the periorbita adjacent to
an opacified sinus. Imaging studies may show evidence of inflammatory
or infective changes in the orbital structures. In the pediatric group,
more patients may have subperiosteal abscess as compared to the adult
group at the time of initial presentation. For example, in the series
reported by Ferguson and McNab,5 among children, 29% had
inflammatory change only, 62% had a subperiosteal abscess, while only
9% had orbital abscesses, compared with 72%, 5%, and 22%,
respectively, in the adult group. In addition to its essential role in the
diagnosis of orbital abscess, CT-scan may also influence the initial
therapeutic plan by demonstrating the size and location of the abscess
and the specific sinuses involved, factors that may be considered if
surgical drainage is considered.1,16 However, CT-scan characteristics of
subperiosteal collection may not be predictive of the clinical course. For
example, the findings in patients who recovered with antibiotic therapy
alone were similar to the findings in patients who underwent surgical
drainage.17 It has been shown that the size of an orbital abscess on
imaging studies may increase during the first few days of intravenous
antibiotics regardless of the bacteriologic response to the
treatment.17 The identification of orbital abcess is a diagnostic challenge.
The reliability of CT-scan in demonstrating orbital abcess has been
questioned. In a series of 25 cases of orbital infection, all 15 orbital
abscesses were satisfactorily demonstrated provided the CT examination
included coronal sections.28 According to this study, one-third of
abscesses would have been missed if coronal sections had been omitted.
Magnetic resonance imaging (MRI) may be necessary in some cases
where CT-scan have not satisfactorily addressed clinician's concerns with
other imaging techniques.
The development of an orbital abscess does not correlate specifically
with visual acuity, proptosis, chemosis, or any other sign.13 Therefore,
diagnostic procedures are essential in evaluating the patient with orbital
cellulitis for possible abscess or retained orbital foreign body. Sinus x-ray
can demonstrate an air-fluid level, if present, in an abscess cavity;
however, gas-free abscesses may not be readily visible.13 Ultrasound can
detect an abscess of the anterior orbit or medial wall with 90%
efficiency,20although an acute abscess may be poorly delineated. The
investigative procedure of choice to diagnose orbital infection is the CT-
scan.1,29 Orbital walls, extraocular muscles, optic nerve, intraconal area,
and adipose tissue can be clearly seen. An orbital abscess is visualized as
a homogenous, a ring-like, or a heterogeneous mass and the site of
origin, orbital or subperiosteal, and extent of abscess are readily
visible.1,17 Contrast-media can enhance the surrounding wall of an
abscess. CT-scan does not differentiate between preseptal cellulitis and
eyelid edema but will differentiate between preseptal and orbital
cellulitis.13 Sinus disease and intracranial complications will also be
evident on CT-scan, as will most foreign bodies. Thus, CT-scan is the
most comprehensive source of information on orbital infections and the
most sensitive means of monitoring the resolution of orbital or
intracranial lesions. CT-scan is indicated in all patients with periorbital
inflammation in whom proptosis, ophthalmoplegia, or a decrease in visual
acuity develops, also in cases where a foreign body or an abscess is
suspected, in cases where severe eyelid edema prevents an adequate
examination, or in whom surgery is contemplated.1,13,16,17,29
BACTERIOLOGY OF ORBITAL ABSCESSES
Commonly reported bacteria from the abscesses of the orbit
include Staphylococcus aureus, Staphylococcus epidermidis,
Streptococci, Diphtheroids, Haemophilus influenza, Escherichia coli and
multiple species including aerobes and anaerobes. No growth in up to
25% of abscesses.13 The results of microbiological investigation by
Ferguson and McNab5 varied with differences in the rate of testing
between the pediatric age group and the older age group. Some form of
culture was performed in 93% of their patients.5 Among 50% of patients,
who had blood cultures performed, none yielded positive results.5 In
their5 study, cultures taken from abscesses were more likely to produce
positive results. There was no correlation between conjunctival swab
cultures and the etiological organism recovered from the abscesses of
patients with positive cultures.5 S. aureus was the most common
pathogen.5 In the pediatric group various species
of Streptococcus predominated.5 Anaerobic Streptococcus was isolated in
four pediatric patients, two cases with mixed anaerobes and one
with Clostridium bifermentans.5 Anaerobic orbital cellulitis was much
less common in adults, with only one case of mixed anaerobes. Multiple
organisms were isolated in only five adults and four pediatric patients.
No pathogens were isolated from six adults and 15 pediatric patient by
Ferguson and McNab.5 In the past,H. influenza was a major pathogen
responsible for orbital cellulitis in the pediatric age group.1,13 In the
series reported by Ferguson and McNab,5 no cases of H. influenza were
detected in the pediatric age group and only one case was found in an
adult patient. The authors5 attributed this observation due to the general
immunization of children with H. influenza type B vaccine since the early
The bacteriology of orbital abscesses has received little attention. In a
study of cultures of the contents of the abscess cavity, a wide range of
organisms including S. aureus, S. epidermidis and Streptococci, H.
influenza, E. coli, and diptheroids have been reported. The role of
anaerobes, not usually considered pathogens in sinus disease, is unclear.
However, a considerable number of cultures in adults have yielded
anaerobes.1,16,18 Patients in the first decade of life generally have
infections caused by single aerobic pathogens which are usually
responsive to medical therapy alone. Patients older than 15 years of age
have complex infections caused by multiple aerobic and anaerobic
organisms that are slow to clear despite medical and surgical
intervention.18 The complexity of pathogens and responsiveness to
antimicrobial therapy appear to be age related.16,30 As the size of the
sinus cavities enlarge, the ostia appear to narrow with increasing age
creating optimal conditions for anaerobic bacterial growth. With
increasing age, there is a trend toward more complex infections. In
mixed infections, aerobes consume oxygen which encourages anaerobic
microbial growth. Additionally, anaerobes produce B-lactamase that
renders antibiotics ineffective. Harris,16 reviewed the microbiology
results of 37 of his patients with orbital abscesses. Twelve patients were
younger than 9 years. Of these, 58% were culture negative and the rest
had a single aerobic pathogen. Sixteen patients between ages 9–14 years
showed a transition toward more complex infections.16 Nine patients
older than 15 years, were all culture positive after more than 3 days of
antibiotic therapy. From the older group, polymicrobial infections were
recovered more often and anaerobes were found in all cases.16
From their vast experience with orbital abscesses, Harris and
Garcia,18 concluded that surgical therapy for orbital abscesses should be
influenced by several factors, including the visual status, the size and
location of the orbital abscess, intracranial complications, the sinuses
involved, the presumed pathogens, and the anticipated bacterial
response to antibiotic treatment. Harris and Garcia recommended
emergency drainage of the orbital abscesses and sinuses of patients of
any age whose optic nerve or retinal function is compromised. Urgent
drainage was also recommended for large abscesses or extensive
superior or inferior abscesses that might not resolve quickly, even if
sinusitis is medically cleared. Urgent drainage was also recommended
for intracranial complications at the time of presentation and in frontal
sinusitis, in which the risk of intracranial extension is increased, and
when complex infections that include anaerobesare suspected. An
expectant approach has been recommended for patients younger than 9
years of age in whom simple infections are suspected. Surgery may be
warranted if: there is no clinical improvement in a timely manner;
relative afferent pupillary defect develops at any time; fever does not
abate within 36 h, suggesting that the bacteremia is not responding to
the choice of antibiotics; if there has been deterioration despite 48 h of
appropriate antibiotic therapy or no improvement despite 72 h of
treatment. Improvement of CT findings should be expected to lag behind
the clinical picture. In fact, the CT findings may seem worse during the
first few days of hospitalization despite successful treatment with
Microbes can cause necrotizing lid disease that is often referred as
necrotizing fascitis.7,31–33 This may progress to systemic manifestation
including potentially fatal toxic streptococcus syndrome, characterized
by multiorgan failure.31,33 These complications can occur in the absence
of antecedent health problems or history of trauma.7,32,33 The virulence of
this organism is related to the production of M proteins and exotoxins A
and B.34 These proteins act as super-antigens in vitro and mediate tissue
necrosis by causing massive release of cytokines such as tumor necrosis
factors and interleukins.
Intravenous antibiotics are usually started once the diagnosis of orbital
cellulitis is suspected. Broad-spectrum antibiotics that cover most gram
positive and gram negative bacteria should be selected. Antibiotic
recommendations are based on the microorganisms most frequently
recovered from abscesses; S. aureus, S. epidermidis, Streptococci,
and Haemophilus species.13 Mixed infections including aerobic and
anaerobic species may be found.16 Cultures from the conjunctiva, nose
and throat are usually not representative of the pathogens cultured from
the abscesses and blood cultures may be frequently negative.13 In many
studies, a combination of a third-generation cephalosporin and
flucloxacillin is used.1,5 Most patients receive oral antibiotics on
discharge for varying periods of time. For example, all patients in the
Ferguson and McNab5 study received intravenous antibiotic treatment
and most of their patients had received multidrug therapy with up to five
different antibiotics. In all cases treatment regimens were empirically
based and instituted prior to identification of the pathogens.5
Patient age has been identified as a factor in the bacteriology and
response to treatment of orbital abscess. In general, children less than 9
years of age have been found to have simpler, more responsive
infections, primarily involving a single aerobic pathogen. Older children
and adults may have more complex infections caused by multiple aerobic
and anaerobic organisms, refractory to both medical and surgical
treatment.16 In addition to starting intravenous antibiotics, emergent
drainage of the orbital abscesses has been suggested in patients with
compromised vision regardless of age. Urgent drainage (within 24 h of
presentation) has been recommended for large abscesses, for extensive
superior or inferior orbital abscesses, for patients with intracranial
complications, for infections of known dental origin in which anaerobes
might be expected.16 An individualized therapeutic approach requires a
clinician to carefully follow these children and to exercise surgical option
if improvement does not occur in a timely fashion. Careful monitoring of
the clinical course is mandatory and comparison of serial CT-scan may be
necessary as an adjunct to clinical judgment. In a previous study by
Harris,16 children younger than 9 years old recovered with antibiotic
treatment alone with successful clinical outcomes. Harris16 describes a
“sliding scale” of risk associated with increasing age and argues that
patients in the older age group who present with orbital cellulitis should
undergo prompt sinus surgery, even before orbital or intracranial
abscesses develop. Once sinus infection in older children or adults has
extended in the orbit as an abscess, urgent drainage should include the
orbit and all infected sinuses.16 CT-scan may not be accurate in assessing
clinical course in some of these patients. In a review of 37 cases of
orbital abscesses, Harris16, found that subperiosteal material could not be
predicted from the size or relative radiodensity of the collections in CT
scans.17 Initial scans were not predictive of the clinical course. Serial
scans showed enlargement of abscesses during the first few days of
intravenous antibiotic therapy, regardless of the ultimate response to
treatment. Harris, concluded that expansion of orbital abscess in serial
CT scans during the first few days of treatment should not be equated to
failure of the infection to respond to antibiotics alone.17
Surgical treatment is indicated for significant underlying sinus disease,
orbital or subperiosteal abscess or both in the pediatric age group. In
adults, sinus surgery remains the most common surgical intervention.
The argument remains between early drainage of orbital abscess to
prevent complications versus the possibility of seeding the infection
through early surgery.16 Harris has outlived a useful approach in the
management of an orbital abscess.16 He recommends emergency
drainage for patients of any age, whose visual function is compromised.
Urgent drainage, usually within 24 h, is indicated for the following: large
orbital abscess causing discomfort, superior or inferior orbital abscess,
evidence of intracranial extension, involvement of frontal sinuses, and a
known dental source of the infection in patients older than 9 years
[Figure 4].16 An expectant approach is indicated for patients younger
than 9 years with medial subperiosteal abscess of modest size, no visual
loss and no intracranial or frontal sinus involvement. Careful evaluation
and close monitoring of the optic nerve function and the level of
consciousness and mental state of the patient is very important. An
incision down to the periosteum at the inner quadrant of the orbit may be
made to drain the subperiosteal abscess. A drain may be inserted and
tissues may not need to be sutured, but left to granulate. The drain may
be left in place for 7–8 days. Functional endoscopic sinus surgery (FESS)
has been shown to be effective for the treatment subperiosteal abscess
due to complication of paranasal sinusitis. The advantage of FESS is the
avoidance of external ethmoidectomy and associated external facial scar
and an early drainage of the affected sinuses and subperosteal abcess.35
MECHANISM OF VISUAL LOSS IN ORBITAL CELLULITIS
Permanent loss of vision has been noted as a complication of orbital
infection since 1893 and blindness was reported in up to 20% of patients
with postseptal inflammation in the preantibiotics era.6 However,
permanent loss of vision resulting from orbital inflammation is unusual in
this era of antibiotics.20,21In a previous study, 4 of 38 patients with
postseptal disease had permanent loss of vision with one of these
patients progressing to no light perception.21 The mechanism for loss of
vision with orbital inflammation may involve: (1) optic neuritis as a
reaction to adjacent or nearby infection; (2) ischemia resulting from
thrombophlebitis along the valveless orbital veins or; (3)
compressive/pressure ischemia possibly resulting in central artery
occlusion.6,21 Because clinical examination by itself may not exactly
delineate the nature of postseptal inflammatory processes, clinicians may
have to rely on imaging studies to select potential surgical candidates.
Despite modern imaging techniques, the clinician must rely on the
clinical progression of the inflammation based on visual acuity testing,
pupillary reactivity, and ocular motility assessment. Patt and
Manning,21 reported four cases of permanent blindness as a result of
postseptal orbital inflammation. In each case, CT-scan readings of “no
definite abscess” contributed to delay in diagnosis of orbital abscess,
with a resultant delay in surgical drainage.
The ethmoidal sinuses are separated from the orbital contents by the
lamina papyracea and anterior and posterior ethmoidal foramina serve as
additional connections that may allow infection to gain access from
ethmoidal air cells to the orbital contents. The periorbita in this area is
loosely attached to bone and may be elevated by a purulent collection,
resulting in subperiosteal abscess. Severe irreversible visual loss may
occur in cases with orbital and subperiosteal abscess. In a survey of 46
cases with a confirmed diagnosis of orbital and subperiosteal abscess in
which visual results were reported, permanent blindness developed in
seven (15%) cases.36 In four cases, blindness was attributed to central
retinal artery occlusion, in two cases optic atrophy occurred, and in one
case no details were provided. Irreversible visual loss in orbital cellulitis
probably has a vascular cause, whereas cases with reversible visual loss
that respond to antibiotic therapy and drainage procedures most likely
are due to infiltrative or compressive optic neuropathy. The confinement
of the optic nerve in the orbital apex and within the bony canal and its
proximity to the posterior ethmoid and sphenoid sinuses magnify the
importance of the casual factors in posterior orbital cellulitis. Clinicians
should be aware that patients with sinusitis and associated orbital
cellulitis are at risk for developing severe visual loss and should be
treated promptly. Hornblass13 reviewed 148 patients from 13 series
reporting orbital abscess and found three cases of no light perception
Acute visual loss may be associated with acute sinusitis either secondary
to complicated orbital cellulitis or as a part of the orbital apex
syndrome.37 El-Sayed and Muhaimeid,37 reported two cases of acute
visual loss as a complication of orbital cellulitis due to sinusitis. In one
patient dramatic improvement in vision from hand motion to normal
vision resulted after intravenous treatment of pansinusitis and associated
orbital cellulitis.37 A second patient (a 10-year-old female) recovered
vision from no light perception to normal levels after exploration of the
sphenoid and ethmoid sinuses along-with intravenous antibiotics. Slavin
and Glaser,36,37 described three cases of sphenoethmoiditis causing
irreversible visual loss associated with minimal signs of orbital
inflammation and renamed the entity “posterior orbital cellulitis.” Slavin
and Glaser36,37 defined it as a clinical syndrome in which early severe
visual loss overshadows or precedes accompanying inflammatory orbital
signs. Acute blindness may also result from orbital infarction syndrome.
Orbital infarction is a disorder that may occur secondary to different
mechanisms such as: (i) acute perfusion failure, that is, common carotid
artery occlusion; (ii) systemic vasculitis, that is, giant-cell arteritis; (iii)
orbital cellulitis with vasculitis, that is, mucurmycosis. The blindness and
retinal and optic nerve damage can be permanent.38 In developing
countries, most patients with sinusitis and orbital abscess tend to present
late in the course of the disease. Most patients with refractory or
complicated subperiosteal abscesses are older children or adults. For
example, in one of the largest studies reported, four patients were
permanently blind out of 159 patients with orbital complications of
sinusitis.21 All four had surgically confirmed subperiosteal abscess, and
all were 15 years of age or older. In another study, among the 13 patients
with intracranial abscess that resulted from sinusitis or orbital abscesses,
two patients were 9 to 14 years of age and 11 were 15 years of age or
Penyebab Dan Gejala Selulitis Orbitalis
Penyebab Selulitis Orbitalis
Penyebab terjadinya selulitis orbitalis adalah infeksi bakteri. Infeksi bisa berasal dari sinus, gigi atau aliran darah, atau bisa terjadi setelah suatu cedera mata. Pada anak-anak, selulitis orbitalis biasanya berasal dari infeksi sinus yang disebabkan oleh Hemophilus influenzae. Bakteri lainnya yang bisa menyebabkan selulitis orbitalis adalah Staphylococcus aureus, Streptococcus pneumoniae dan streptokokus beta hemolitikus yang menyerang tubuh penderita.
Kondisi predisposisi untuk selulitis termasuk gigitan serangga, melepuh, gigitan hewan, tato, ruam gatal kulit, operasi terakhir, athletes foot, kulit kering, eksim, obat suntikan (terutama subkutan atau injeksi intramuskular atau mana injeksi IV berusaha “merindukan” atau pukulan vena), kehamilan, diabetes dan obesitas, yang dapat mempengaruhi sirkulasi, serta luka bakar dan bisul, meskipun ada perdebatan mengenai apakah lesi kaki kecil berkontribusi.
Selulitis disebabkan oleh jenis bakteri memasuki kulit, biasanya dengan cara dipotong, abrasi, atau istirahat di kulit. Istirahat ini tidak perlu terlihat. Streptococcus Grup A””dan””aureus adalah yang paling umum dari bakteri ini, yang merupakan bagian dari flora normal kulit tetapi tidak menyebabkan infeksi yang sebenarnya, sementara di permukaan luar kulit.
Penampilan kulit akan membantu dokter membuat diagnosis. Dokter mungkin juga menyarankan tes darah, budaya luka atau tes lainnya untuk membantu menyingkirkan gumpalan darah di dalam pembuluh darah kaki. Selulitis di tungkai bawah ditandai dengan tanda dan gejala yang mungkin serupa dengan bekuan terjadi jauh di dalam pembuluh darah, seperti kehangatan, nyeri dan pembengkakan (inflamasi).
Ini memerah kulit atau ruam mungkin sinyal infeksi lebih dalam, lebih serius dari lapisan dalam kulit. Setelah di bawah kulit, bakteri dapat menyebar dengan cepat, memasuki kelenjar getah bening dan aliran darah dan menyebar ke seluruh tubuh.
Dalam kasus yang jarang terjadi, infeksi dapat menyebar ke lapisan dalam dari jaringan yang disebut lapisan fasia. Necrotizing fasciitis, juga disebut oleh media
“bakteri pemakan daging,” adalah contoh dari infeksi yang mendalam-lapisan. Ini merupakan keadaan darurat medis ekstrim.
Gejala Sakit mata selulitis Orbitalis
Sakit mata selulitis Orbitalis (SO) memiliki gejalan yaitu seperti :
-Kelopak mata bengkak
-Bola mata menonjol dan bengkak
Pemeriksaan untuk penyakit Sakit mata selulitis Orbitalis (SO) ini bisa dicek melalui rontgen gigi dan mulut atau CT Scan sinus. SO yang tak segera ditangani bisa berakibat fatal, seperti kebutaan, infeksi otak atau pembekuan darah di otak.
Penanganan Sakit mata selulitis Orbitalis
Penanganan gejala sakit mata selulitis orbitalis dapat dilakukan tindakan yaitu :
-Penderita sakit mata selulitis orbitalis diberikan antibiotika secara oral.
-Penderita sakit mata selulitis orbitalis bisa diberikan operasi pembedahan untuk mengeluarkan nanah
Diagnosa Selulitis Orbitalis
Mendiagnosa harus ditegakkan berdasarkan gejala dan hasil pemeriksaan fisik.Untuk menentukan penyebabnya bisa dilakukan rontgen gigi dan mulut atau CT scan sinus.Contoh jaringan dari selaput mata, kulit, darah, tenggorokan atau sinus bisa dibiakkan di laboratorium untuk menentukan bakteri penyebab infeks tersebuti.
Cara Mengobati Selulitis Orbitalis
Pengobatan dilakukan adalah pada kasus yang ringan diberikan antibiotik per-oral dan untuk kasus yang berat antibiotik diberikan secara intravena (melalui pembuluh darah). Kadang perlu dilakukan pembedahan untuk membuang nanah atau mengeringkan sinus yang terinfeksi
Periorbital and Orbital Cellulitis
Management - Orbital Cellulitis
This is a surgical emergency. After consultation with the ENT surgeons and ophthalmologists, an urgent CT scan
should be arranged to differentiate those patients with an associated abscess (usually subperiosteal) from those
without. This should be discussed with the radiologist who will ask for coronal views. Imaging should pay particular
attention to the orbital and frontal regions as the abscess may be small.
Surgical drainage of an abscess results in decompression of the orbit and obtains infected material for Gram stain
Likely organisms include Strep pyogenes, Strep pneumoniae and Staph aureus. Over 5 years Staph aureus is more
common. Haemophilus influenzae type b is less common since HiB immunisation.
i.v. Ceftriaxone 50 mg/kg/dose (2g) iv 12H
i.v. flucloxacillin 50 mg/kg/dose 6-hourly (maximum 2 g/dose).
Lumbar puncture is contraindicated in patients with orbital cellulitis until after the CT scan has been performed,
even in the absence of features of raised intracranial pressure, since intracranial extension may be silent.
Management - Periorbital Cellulitis
Investigation of these patients should include FBE, blood cultures.
Likely organisms include Strep pyogenes, Strep pneumoniae and Staph aureus. Strep pyogenes and Staph aureus
are likely if there is a contiguous skin lesion. Rarely Haemophilus influenzae may be the cause particularly in
children under five who are not fully immunised.
Haemophilus bacteraemia-induced periorbital cellulitis and Haemophilus meningitis occasionally coexist. The
decision as to whether a lumbar puncture should be performed should be a clinical one.
(400/57 mg per 5 mL)
0.3 mL/kg (11 mL) po 12H
Moderate Flucloxacillin 50 mg/kg (2 g) iv 6H
or <5y & not Hib immunised
Flucloxacillin 50 mg/kg (2 g) iv 6H
andCeftriaxone 50 mg/kg/dose (2g) iv 12H
In children who are systemically unwell it may be reasonable to use both Ceftriaxone 50 mg/kg/dose (2g) iv 12H
and flucloxacillin initially. Any child in whom there is a reasonable suspicion of primary skin infection, or who is not
improving on Ceftriaxone 50 mg/kg/dose (2g) iv 12H alone should have flucloxacillin added. Failure to respond in
24-48 hours may indicate orbital cellulitis or underlying sinus disease. Treat as for orbital cellulitis.
When improving, and no organism identified change to augmentin 25 mg/kg/dose, 8-hourly (maximum 500
mg/dose) for 7 days.
If Haemophilus influenzae type b is isolated, rifampicin prophylaxis should be given as for meningitis, that is, if a
child aged 5 years or less lives in the same household as the index case or if the index case is < 2 yr, then
prophylaxis should be given to the entire household, including the index case. Parents who are pregnant should
not be given rifampicin. Patients should be warned that rifampicin will colour the urine tears and other secretions
orange, orange tears may discolour contact lenses. Rifampicin induces the metabolism of the oral contraceptive
pill making this form of contraception unreliable.
< 1 month: 10 mg/kg once daily for 4 days > 1 month: 20 mg/kg once daily for 4 days Adults: 600 mg once daily for 4 days
All children aged < 5 yr who have not been immunised against Hib should be vaccinated. If children are < 2 yr and
have had a documented Haemophilus infection they should be immunised.
Local allergic reactions
In the absence of local and systemic signs of infection eg temperature or tenderness, periorbital erythema
may be an allergic reaction rather than periorbital cellulitis.
What is orbital cellulitis?Orbital cellulitis is an infection or inflammation of the orbit. Since the orbit has direct communications with the sinuses, infection can spread into the orbit in a patient with a sinus infection. Orbital cellulitis is potentially much more serious than preseptal cellulitis.
What causes orbital cellulitis?Spread of infection is the most common cause of orbital cellulitis. Causes include:
• Sinusitis (the most common cause)• Trauma or foreign body• Infection from the blood• Tooth abscess
How is orbital cellulitis evaluated?A history and physical examination is performed. Blood may be tested for infection. An imaging study (CT scan or MRI) may be obtained to evaluate for spread into and possibly beyond the orbit.
How is orbital cellulitis treated?Treatment for orbital cellulitis usually involves admission to the hospital for close observation and intravenous antibiotic therapy. Consultation by an Ophthalmologist and possibly an Ear-Nose & Throat specialist are often recommended . Surgery to drain the orbital and sinus infection may be necessary if the condition does not improve or worsens. Patients are monitored carefully for loss of vision or evidence of pressure on the optic nerve.
What are the complications of orbital cellulitis?Spread to surrounding tissue can cause significant worsening of the illness. Spread to the brain from the sinuses and orbit may cause a brain abscess (walled off infection), meningitis (infection in tissues surrounding the brain) and/or hydrocephalus (increased pressure in the brain). These serious complications often require intensive care and possibly emergency surgery. Rarely, these complications may result in death.However, orbital cellulitis usually responds to proper treatment and there is generally full recovery
Eye Socket Infection (Orbital Cellulitis)
What is orbital cellulitis?
Orbital cellulitis is a severe infection inside your eye socket, which is called the orbit.
Orbital cellulitis is an emergency. It can cause permanent blindness if not treated right away.
What is the cause?
Eye socket infections can start after a surgery or an injury to the eye. Sinus or dental infections, or skin infections around your eye and eyelids can spread to your eye socket through the thin bones and veins near your eye. Also, an infection that starts somewhere else in your body can spread through the bloodstream to your eye.
Eye socket infections are usually caused by bacteria. Fungus may cause this infection if you have if your immune system is weakened by diabetes, HIV, chemotherapy, or other conditions. Fungus is a kind of germ. It includes things like yeast, mold, and mildew.
What are the symptoms?
Symptoms may include:
Decreased vision or double vision Pain, swelling, and redness in and around your eye
Watery, yellow, or green discharge from your eye
Problems moving your eye in one or more directions
One eye looks like it bulges forward compared to the other eye
You may have a runny nose or a stuffy nose with these symptoms.
How is it diagnosed?
Your eyecare provider will ask about your symptoms and medical history, and do exams and tests such as:
An exam using a microscope with a light attached, called a slit lamp, to look closely at the front and back of your eye An exam using drops to enlarge, or dilate, your pupils and a light to look into the back of your eyes
CT scan, which uses x-rays and a computer to show detailed pictures of your eye socket
MRI, which uses a strong magnetic field and radio waves to show detailed pictures the bones and tissues of your eye socket and sinuses
Lab tests of the discharge from your eye
Blood tests to check for signs of infection and bacteria in the blood
How is it treated?
If the infection is found and treated quickly, you may have no loss of vision. You may need to stay in the hospital and receive medicines to treat the infection through an IV. You may need surgery to drain the infection.
How can I take care of myself?
Follow the full course of treatment your healthcare provider prescribes. Ask your healthcare provider:
How and when you will hear your test results How long it will take to recover
What activities you should avoid and when you can return to your normal activities
How to take care of yourself at home
What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup.
How can I prevent an eye socket infection?
If you think you have an infection of the skin around your eye or of your eyelids, contact your healthcare provider. If you have a history of sinus infections and develop eye symptoms, you should also seek medical attention.
Selulitis Orbita Akuto Suatu keadaan akut dari jaringan orbita yang disebabkan oleh kuman.
o Kuman yang sering menyebabkan sinusitis atau dakrioadenitis seperti pneumokok, streptokok atau stafilokok.
o Infeksi dapat terjadi secara langsung dari radang sinus paranasalis, melalui pembuluh darah & trauma terutama bila ada benda asing yang masuk ke jaringan orbita.
o Gejala klinis:
- Nyeri.Nyeri orbita terutama dirasakan penderita pada perabaan & pergerakan bola mata.- Palpebra bengkak & merah.- Penurunan visus- Proptosis- Gangguan pergerakan bola mata- Diplopia- Panas badan.
- Isterahat total- AB spectrum luas- Infeksi local dicari dan diobati- Insisi abses pada tempat fluktuasi
a. Selulitis Orbita
Selulitis orbita merupakan peradangan supuratif jaringan ikat longgar intraorbita di belakang septum orbita. Selulitis orbita akan memberikan gejala demam, mata merah, kelopak sangat edema dan kemotik, mata proptosis, atau eksoftalmus diplopia, sakit terutama bila digerakkan, dan tajam penglihatan menurun bila terjadi penyakit neuritis retrobulbar. Pada retina terlihat tanda stasis pembuluh vena dengan edema papil.
DATA PENYAKIT, DeskripsiOrbital selulitis adalah infeksi yang berpotensi terhadap komplikasi serius yang berbahaya. Bakteri dari infeksi sinus (sering
Haemophilus influenzae) biasanya menginfeksi anak-anak. Bakteri Staphylococcus aureus, Streptococcus pneumoniae, dan beta-hemolitik streptokokus orbit juga dapat menyebabkan selulitis. Penyebab lainnya termasuk tembel di kelopak mata, gangguan gigitan, atau kelopak mata cedera.
Anak umur 6-7 sangat rentan terhadap terinfeksi. Namun, tingkat orbital selulitis telah menurun terus sejak diperkenalkannya Vaksin Hib (Haemophilus influenzae B). Orbital infeksi selulitis pada anak-anak dapat memburuk dengan sangat cepat dan dapat menyebabkan kebutaan. Perhatian medis segera diperlukan.
Gejala* Demam, umumnya 102 derajat F atau lebih tinggi* Menyakitkan pembengkakan kelopak mata atas dan bawah* Mengkilat, merah atau ungu kelopak mata* Mata sakit, terutama dengan gerakan* Penurunan pandangan* Mata melotot* General malaise* Sakit atau sulit menggerakan mata
PengobatanPasien biasanya perlu tinggal di rumah sakit. Perawatan termasuk antibiotik diberikan melalui vena. Pembedahan mungkin diperlukan untuk mengeringkan abses. Orbital infeksi selulitis dapat menjadi lebih buruk dengan sangat cepat. Pasien harus diperiksa setiap beberapa jam.
Selulitis OrbitaA. Definisi
Selulitis orbita adalah peradangan supuratif jaringan ikat jarang intraorbita di belakang septum orbita.1 Selulitis orbita jarang merupakan penyakit primer rongga orbita. Biasanya disebabkan oleh kelainan pada sinusparanasal dan yang terutama adalah sinus etmoid. Selulitis orbita dapat mengakibatkan kebutaan, sehinggadiperlukan pengobatan segera. Pada anak-anak, selulitis orbitais biasanya berasal dari infeksi sinus dandisebabkan oleh bakteri Haemophilus influenzae. Bayi dan anak-anak yang berumur dibawah 6-7 tahuntampaknya sangat rentan terhadap infeksi oleh Haemophilus influenzae.2B. EpidemiologiPeningkatan insiden selulitis orbita terjadi di musim dingin, baik nasional maupun internasional, karenapeningkatan insiden sinusitis dalam cuaca. Ada mencatat peningkatan frekuensi selulitis orbita pada masyarakatdisebabkan oleh infeksi Staphylococcus aureus yang resisten methicillin.1. Mortalitas / MorbiditasSebelum ketersediaan antibiotik, pasien dengan selulitis orbita memiliki angka kematian dari 17%, dan 20% dari korban yang selamat buta di mata yang terkena. Namun, dengan diagnosis yangcepat dan tepat penggunaan antibiotik, angka ini telah berkurang secara signifikan; kebutaan terjadidalam 11% kasus. Selulitis orbita akibat S. aureus yang resisten terhadap methicillin dapatmenyebabkan kebutaan meskipun telah diobati antibiotik.2. RasSelulitis orbita tidak dipengaruhi oleh rasial.3. SexTidak ada perbedaan frekuensi antara jenis kelamin pada orang dewasa, kecuali untuk kasus-kasus S. aureus yang resisten terhadap methicillin, yang lebih sering terjadi pada wanita daripada laki-laki dengan rasio 4:1. Namun, pada anak-anak, selulitis orbita telah dilaporkan dua kali lebih sering terjadi pada laki-laki daripada perempuan.4. UsiaSelulitis orbita, pada umumnya, lebih sering terjadi pada anak-anak daripada di dewasa muda.Kisaran usia anak-anak yang dirawat di rumah sakit dengan selulitis orbita adalah 7-12 tahun.Etiologi dan Patofisiologi
Selulitis orbita merupakan peradangan supuratif yang menyerang jaringan ikat di sekitar mata,dan kebanyakan disebabkan oleh beberapa jenis bakteri normal yang hidup di kulit, jamur, sarkoid, daninfeksi ini biasa berasal dari infeksi dari wajah secara lokal seperti trauma kelopak mata, gigitan hewanatau serangga, konjungtivitis, kalazion serta sinusitis paranasal yang penyebarannya melalui pembuluhdarah (bakteremia) dan bersamaan dengan trauma yang kotor.Pada anak-anak infeksi selulitis sering disebabkan oleh karena sinusitis etmoidalis yangmengenai anak antara umur 2-10 tahun. Ada Beberapa bakteri penyebab, diantaranya :a. Haemophilus influenzaeMerupakan bakteri yang bersifat gram negatif dan termasuk keluarga Pasteuracella. Haemophilusinfluenzae yang tidak berkapsul banyak diisolasi dari cairan serebrospinalis, dan morfologinya sepertiBordetella pertussis penyebab batuk rejan, namun bakteri yang didapat dari dahak besifat pleomorfik dan sering berbentuk benang panjang dan filamen.Gambar Haemophilus influenzaeyang diperoleh dari dahak.Haemophillus influenzae dapat tumbuh dengan media “heme” oleh karena media ini merupakanmedia kompleks dan mengandung banyak prekursor-prekursor pertumbuhan khususnya faktor X(hemin) dan faktor V( NAD dan NADP ). Di laboratorium di tanam dalam agar darah cokelat yang sebelumnya media tanamtersebut dipanaskan dalam suhu 80oC untuk melepaskan faktor pertumbuhan tersebut. Bakteri dapattumbuh dengan baik pada suhu 35oC- 38oC dengan PH optimal sebesar 7,6. Bakteri ini dapat tumbuhpada kondisi aerobik ( sedikit CO2). Bakteri ini sekarang sudah jarang untuk menyebabkan selulitisakibat banyaknya tipe vaksinasi untuk strain ini
Selulit Mata?Oleh : Dr. Dito Anurogo
28-Mar-2008, 13:07:16 WIB - [www.kabarindonesia.com]KabarIndonesia - Yang dimaksud dengan selulit mata disini adalah selulitis orbita. Jadi amat jauh berbeda dari selulit menurut pengertian awam. Mari kita pahami apa itu selulitis orbita.
Definisi:Selulitis orbita adalah peradangan jaringan ikat yang terdapat di dalam rongga orbita.
Penyebab:1. Kuman piogenik (Pneumococcus, Staphylococcus, dan Streptococcus).2. Lues, jamur, dan sarkoid dapat menyebabkan selulitis orbita kronik.3. Haemophilus influenzae menyebabkan selulitis orbita pada anak.4. Staphylococcus aureus dan Streptococcus sp. menyebabkan selulitis orbita pada pada orang dewasa.5. Trauma tembus yang kotor yang masuk ke dalam rongga orbita.
Manifestasi Klinis:1. Badan terasa panas2. Tajam penglihatan (visus) menurun3. Penglihatan ganda (diplopia)4. Daerah yang meradang terasa sakit, terutama pada perabaan.5. Kelopak mata merah dan bengkak.7. Konjungtiva bulbi berwarna merah.8. Pada perabaan bola mata terasa sangat sakit.9. Terkadamg bola mata sama sekali tidak dapat digerakkan.10. Terkadang terlihat perdarahan papil akibat tekanan dari belakang bola mata.11. Malaise (tubuh merasa tidak enak, tidak nyaman)12. Leukositosis (sel darah putih meningkat karena infeksi)13. Keadaan umum penderita biasanya buruk sekali.
Penatalaksanaan:1. Istirahat penuh/total dengan dirawat2. Antibiotik dosis tinggi intravena atau intramuskular yang sesuai.3. Jika perlu, abses dikeluarkan. Namun hati-hati, karena dapat menimbulkan penyulit baru.
Penyulit:1. Trombosis sinus kavernosus2. Meningitis3. Abses otak4. Panoftalmitis5. Neuritis
Prognosis:Sukar diramalkan. Bila pengobatan terlambat, hasilnya lebih buruk.
1. Selulitis orbita jarang merupakan penyakit primer rongga orbita. Biasanya disebabkan oleh kelainan pada sinus paranasal dan yang terutama adalah sinus etmoid.
2. Selulitis orbita dapat mengakibatkan kebutaan, sehingga diperlukan pengobatan segera.