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Orbital Cellulitis

Orbital cellulitis is an acute infection of the tissues immediately surrounding the eye, including the eyelids, eyebrow, and cheek. Orbital cellulitis is an infection of the soft tissues of the orbit posterior to the orbital septum, differentiating it from preseptal cellulitis, which is an infection of the soft tissue of the eyelids and periocular region anterior to the orbital septum. The examining physician may find proptosis (forward displacement of the eye), an abnormal pupil reaction, restricted movement of the eye, and swelling of the optic nerve . A CT scan confirms the diagnosis and may further be necessary to rule-out a foreign body in the orbit (eye socket). A physician should be called if a child exhibits any swelling of the eyelid, especially if it is associated with fever. True orbital cellulitis (post-septal, behind the septum) is a very dangerous infection because germs have direct access to the brain through the veins that drain the eye region. Entry of bacteria into the brain and spinal fluid system would result in dangerous bacterial meningitis. Among children, orbital cellulitis - and the less serious infection but still important periorbital cellulitis - is most often caused by the organism Hemophilus influenzae . Orbital cellulitis is an infection that involves the eye and the eye structures within the bony cavity of the face. Both of these conditions are serious and require immediate medical attention by your child's physician.

Orbital Cellulitis most often presents with symptoms similar to preseptal cellulits such as red and swollen eyelids, but also includes pain, blurred or double vision, fever, headache, and a red eye. This combination of thin bone, foramina for neurovascular passage, and naturally occurring defects in the bone allows for easy communication of infectious material between the ethmoidal air cells and the subperiorbital space in the medial aspect of the orbit. Periorbital cellulitis involves the area from the skin of the eyelid to the bony area that encloses the eye Because of the danger of developing into widespread blood-born or central nervous system infections , infections around the eye are often treated intravenously in the hospital. True orbital cellulitis requires very aggressive intravenous antibiotic therapy, and generally speaking, only the milder periorbital (preseptal) infections are treated orally. In patients who are immunocompromised or have diabetes, a life-threatening fungal infection known as Mucormycosis must be considered. Infants and children up to the age of seven seem to be particularly susceptible to infection with Hemophilus influenzae and are most at risk. The actual incidence is not reported, but it is a rare infection.

Causes of Orbital cellulitis

The common causes of Orbital cellulitis :

• Infections can also occur after eye trauma.
• Streptococcus pyogenes
• The most common infections are due to bacteria
• Staphylococcus aureus is the most common cause in adults.
• Surgical procedures, including orbital decompression, dacryocystorhinostomy, eyelid surgery, strabismus surgery, retinal surgery, and intraocular surgery, have been reported as the precipitating cause of orbital cellulitis. Postoperative endophthalmitis can extend to the orbital soft tissues.
• Bacterial causes of orbital cellulitis are most commonly Streptococcus species, S aureus , and Haemophilus influenzae type B. Pseudomonas, Klebsiella, Eikenella, and Enterococcus are less common culprits. Polymicrobial infections with aerobic and anaerobic bacteria are more common in patients aged 16 years or older.
• Fungi are seen in those with a weak Immune or body defense system.
• Haemophilus influenzae

Symptoms of Orbital cellulitis

Some common symptoms of Orbital cellulitis :

• Conjunctiva (the lining of the eye lids and the eye surface) may become red and begin to itch.
• Fever , generally 102 degrees F or greater.
• Pain around the eye and upon eye movement
• Infant or child is acutely ill or toxic.
• Redness or swollen eyelids and eyes.
• Decreased vision (because the lid is swollen over the eye).
• fever
• swelling of the upper and lower eyelid
• warmth of skin
• Restricted eye movements.

Treatment of Orbital cellulitis

• If there is Influenza or cellulites, an antibiotic called Rifampin should be given to the entire family for prevention.
• your child's age, overall health, and medical history
• the extent of the condition
• Mild cases are treated with antibiotics at home
• An afferent pupillary defect develops
• your child's tolerance for specific medications, procedures, or therapies
• If an Abscess develops, surgical drainage may be needed.
• These infections can progress rapidly, and they must be carefully followed every few hours.
• Proptosis progresses despite appropriate antibiotic therapy
• Surgical drainage of an abscess may be necessary.

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