Eye cellulitis

A bacterial infection spreading to the tissues of the orbit or eyelid

Other terms

Preseptal cellulitis
Periorbital cellulitis
Orbital cellulitis
Retroseptal cellulitis

Definition

Generally speaking, cellulitis is an infection that causes inflammation of the skin and soft tissues. Cellulitis of the eye occurs when a bacterial infection spreads to the tissues of the eye socket or eyelid. This condition is generally not contagious, but can have serious consequences.

There are two types of cellulitis of the eye, both caused by an external infection such as a wound:

Preseptal cellulitis is an infection of the eyelid and surrounding skin, in front of the fibrous sheet of the orbit, the membrane that extends from the orbital rim into the upper and lower eyelids. It is usually caused by the spread of infections due to local wounds of the face or eyelid, or secondary to insect bites, animal bites, chalazion ( link to HOJG site) or sinusitis.
Orbital cellulitis is an infection of the orbital tissues behind the fibrous layer of the orbit, affecting the deep tissues of the orbit. It is much less common than preseptal cellulitis. Most often caused by an extension of an infection of the adjacent sinuses, it can, in rarer cases, also be caused by an infection following local trauma (insect bite, animal bite, penetrating wounds of the eyelid) or by the extension of an infection of the face or teeth.

Cellulitis of the eye is an ophthalmological emergency, as it can lead to blindness and brain damage. They are more common in children.

Causes

Cellulitis is caused by a bacterial infection that has spread to the tissues of the orbit.

Preseptal cellulitis is generally secondary to a wound close to the eye, an insect bite, an animal bite, a chalazion or sinusitis.
Orbital cellulitis is generally secondary to the extension of an adjacent sinus infection.

The bacterial strains most frequently implicated are :

Streptococcus pneumoniae
Staphylococcus aureus
Streptococcus pyogenes
Haemophilus influenzae type b (Hib)

Cellulitis is generally not contagious.

Symptoms

The most common symptoms common to both types of eye cellulitis include warmth and swelling of the eyelid, pain, and redness or discoloration of the eyelid.

Orbital cellulitis can also cause fever, malaise, protrusion of the eyeball out of the socket, abnormal eye motility and blurred vision. If headaches and lethargy occur, meningitis should be suspected.

Diagnosis

Diagnosis is made by the doctor following a clinical examination. Additional tests may be required (blood tests, CT scan, bacteriological culture). Symptoms of orbital cellulitis, particularly in children, should be promptly reported to the emergency room, as complications can be serious.

Treatment

Antibiotic treatment is required for cellulitis of the eye, and must be prescribed as a matter of urgency.

For preseptal cellulitis, outpatient treatment remains an option if orbital cellulitis has been definitively ruled out, but sufferers should be closely monitored by a specialist. Antibiotics are prescribed for 10 days.
Orbital cellulitis generally requires hospitalization with intravenous antibiotic therapy.

Surgery (decompression surgery, drainage of an abscess, opening of an infected sinus) may also be necessary in the following cases:

Infection does not improve despite antibiotic therapy.
Vision is compromised.
Presence of a foreign body or orbital abscess is suspected.

Frequency

Preseptal cellulitis is common, particularly in children.

Orbital cellulitis is a rare complication, affecting around 1 in 100,000 children.

Prevention

A few preventive measures can be taken:

Facial wounds should be carefully cleaned and disinfected.
In the event of sinusitis, appropriate treatment must be put in place to prevent the infection spreading to the orbit, or even to the brain.

Cellulitis of the eye is an ophthalmological emergency, as it can lead to blindness and brain damage.

References

Source : EM Consulte

Contenu revu et contrôlé le 16.01.2025

Diseases