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Cellulitis of the Eye

Periorbital cellulitis and orbital cellulitis are infections of the skin and soft tissues surrounding the eye. Generally, either condition affects only one eye. While swelling around the eye is the most common symptom, eyelid cellulitis can become serious and lead to complications that may include vision loss. Both periorbital cellulitis and orbital cellulitis are more common in children than in adults.

Types of Cellulitis of the Eye

Although periorbital cellulitis occurs in the front part of the eye, if left untreated, the condition can worsen and new symptoms can develop. Like periorbital cellulitis, orbital cellulitis requires immediate medical treatment to prevent complications. Without proper treatment, either type of cellulitis of the eye can have serious effects on your child's health.

Periorbital Cellulitis

Periorbital cellulitis is inflammation that involves the eyelid and skin covering the bony area around the eye. The infection can affect one or both eyelids of an eye and is most common in children younger than age 2.
Often the cause is a minor eye injury, such as a small cut, scratch or bug bite, that gives bacteria a place to enter. Conjunctivitis, an upper respiratory infection, or a bacterial infection that spreads from the sinuses are other causes of eyelid cellulitis. Sometimes eye trauma or a fungus is the cause.

Orbital Cellulitis

When cellulitis of the eyelid spreads to the eye socket, or tissue behind the eye, the condition is called orbital cellulitis. Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae - also known as H. influenzae - are bacteria that cause eye, ear and sinus infections in infants and children that can lead to periorbital or orbital cellulitis. Reports show that 90% of orbital cellulitis cases stem from acute or chronic sinusitis.
Eyelid Cellulitis Symptoms
While both types of eyelid infections cause general eye discomfort, symptoms of periorbital cellulitis include redness and swelling of the eyelids and skin around the eye. Although the condition doesn't normally affect a child's vision or cause pain, the swollen area may be tender to the touch.
Symptoms of orbital cellulitis vary by child; however, common symptoms include swelling of the upper and lower eyelid, fever and irritability. The affected eye may look like it's bulging forward.
Your child may also experience decreased visual acuity, blurred or double vision and pain when moving their eye. In some cases, the eye may be swollen shut or your child may have trouble moving the eye.

Potential Complications

Both periorbital and orbital cellulitis are serious infections that require prompt medical attention as the infection spreads quickly. Along with other medical specialists, your child needs to see an eye doctor if the infection spreads beyond the eyelid and orbital cellulitis develops.
If not treated immediately, either condition can lead to complications. Permanent vision problems or blindness can occur, especially if the infection spreads to the other eye. In rare cases, a child can develop a brain abscess or meningitis.


If clinical examination is difficult in a young child or symptoms of sinus infection are present, a doctor may order a CT or MRI of the sinuses and orbit. A doctor may also order a blood culture and culture of eye or nose drainage to identify the type of bacteria present.
Doctors treat periorbital cellulitis by prescribing oral antibiotics but only if your child shows no signs that the infection has spread beyond the eyelid and surrounding facial skin. Just as adults, children require follow-up with an eye doctor until the infection is gone.
Orbital cellulitis normally requires more aggressive treatment, which may include hospitalization so that your child can receive antibiotics intravenously. Either condition usually improves quickly once a child begins receiving antibiotics to fight the bacterial infection. Sometimes, however, a doctor needs to surgically drain the sinuses or an abscess to relieve pressure in and around the eye.
If you are concerned about your child's eye health, the eye physicians at Harry W. Chan, OD can conduct an eye exam to test their vision and look for possible signs of cellulitis.