Orbital cellulitis is a painful, rare bacterial infection of the soft tissues surrounding the eyeball. Its progression can be rapid and extremely dangerous for the patient, requiring immediate treatment.
It is classified into two types: preseptal and postseptal, depending on the location of the infection.
Postseptal cellulitis involves inflammation of the soft tissues behind the orbital septum, where bacteria settle, multiply, and spread to surrounding tissues. Although rare, this form is extremely severe and dangerous, with the potential to threaten the patient’s life.
Preseptal cellulitis affects the tissues in front of the orbital septum. Rarely, it can progress and lead to generalized orbital cellulitis. This form generally has a better prognosis and presents with milder symptoms.
Orbital cellulitis can present with general symptoms such as fever and fatigue, as well as local symptoms including:
Periorbital pain
In preseptal cellulitis, symptoms such as double vision, decreased vision, proptosis, or restricted eye movements never occur.
Due to the need to determine the source of the bacterial infection, blood cultures, X-rays, or even more specialized examinations may be required.
If the orbital cellulitis is postseptal, MRI of the orbital cavities is considered essential.
Treatment of preseptal orbital cellulitis is straightforward and consists of appropriate administration of antibiotics.
The patient should be closely monitored. Examination of visual acuity, pupillary reflexes, and color perception is essential. If any of these are affected, it may indicate progression to postseptal cellulitis.
Management of postseptal orbital cellulitis must be immediate. Its progression is rapid and extremely dangerous, not only for vision but also for the patient’s life. Treatment primarily involves hospitalization with injectable, intravenous antibiotics.
However, if antibiotics cannot adequately penetrate the confined orbital cavity, surgical intervention becomes necessary for urgent decompression due to an abscess that threatens vision by compressing the optic nerve.
Before the discovery of antibiotics, approximately 20% of cases ended fatally due to the disease spreading, which could lead to sepsis or even meningitis. Other complications that have been observed include loss of vision, hearing loss, and cavernous sinus thrombosis.