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Quick reference medical handouts used by Pediatric offices

What is Periorbital cellulitis?

What is periorbital cellulitis? 
Cellulitis is an infection of the skin and underlying tissues that can affect any area of the body. Cellulitis begins in an area of broken skin, like a cut or scratch, allowing bacteria to invade and spread, causing inflammation, which includes pain, swelling, warmth, and redness. One specific type of cellulitis that can occur in children and requires close monitoring is periorbital cellulitis, an infection of the eyelid and tissues surrounding the eye. It can be the result of minor trauma to the area around the eye (such as an insect bite or a scratch), or it may be the extension of another site of infection, such as sinusitis. Periorbital cellulitis is a serious medical condition and requires immediate medical attention by your child's physician.

What causes peri-orbital cellulitis?
The most common cause of these types of cellulitis is from an infection with bacteria. The following are the bacteria that are usually involved:

  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Haemophilus influenzae
The bacterium gets into the eye and the surrounding cavity many different ways. The two most common ways the infection gets into the eye include the following:
  • trauma
    Direct trauma to the eye can lead to infection from the bacteria.
  • spread from other areas
    Most commonly, the infection begins in the sinuses. The sinuses are cavities, or air-filled pockets, that are near the nasal passage.
What are the symptoms of periorbital cellulitis? 
The following are the most common symptoms of periorbital cellulitis. However, each child may experience symptoms differently. Symptoms appear abruptly and may include:
  • swelling of the upper and lower eyelid
  • redness of the upper and lower eyelid
  • warmth of skin
  • pain
  • decrease in the child's ability to move the eyeball
  • decrease in vision
  • fever
  • general discomfort of the eye

How are pre-septal/orbital cellulitis diagnosed?
Diagnosis is usually based on a complete medical history and physical examination of your child. In addition, your child's physician may order the following tests to help confirm the diagnosis:

  • blood tests
  • x-ray - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. The extent of the infection is detected by performing a CT scan.
  • cultures of the drainage from the eyes or the blood

Treatment of periorbital cellulitis:

Orbital cellulitis is a serious condition and must be treated promptly. Treatment may include:
  • consultation with an ophthalmologist (eye care specialist)
  • antibiotics
    In its early stages, periorbital cellulitis can be treated with oral antibiotics. Your child's doctor will probably want to follow your youngsters progress closely to make sure the drugs are working. But be sure to complete the entire course of antibiotics, even if his symptoms start going away, or the infection could resurface
  • hospitalization
    Your child may be admitted to the hospital for antibiotics through an intravenous (IV) catheter. Hospitalization also allows for close evaluation of your child and the condition.
  • surgery
    Surgical drainage of the sinuses or any abscesses of the eye is sometimes needed.
What are possible complications from periorbital cellulitis?
In rare cases, untreated periorbital cellulitis can progress into orbital cellulitis, a serious eye condition that involves the eye itself and the structures within the orbit (the "eye cavity" or "socket"). This condition may affect your child's vision and ability to move his eyeball, and it usually causes the eye to bulge and sometimes even to swell shut. Orbital cellulitis requires immediate care — usually, imaging by CT scan or MRI and a hospital stay, so that antibiotics can be given intravenously. In some cases, surgery is necessary so that the sinuses, for example, can be drained.

In extremely rare cases, untreated orbital cellulitis can cause permanent vision problems, meningitis, or neurological problems in children. But if you follow through with treatment as prescribed and keep your follow-up appointments, this is highly unlikely. As with any illness, your best defense as a parent is to play it safe and call your doctor whenever you're concerned about your child's symptoms.

Periorbital cellulitis is a serious eye condition that requires immediate treatment. If your child is complaining of eye pain and his upper and lower eyelids are red and swollen, call your doctor right away. (Your child may also have a fever.) If not diagnosed and treated early this condition can cause long-term vision problems and possibly even more serious health problems

posted 05-12-04 on


As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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