By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

PAINFUL ORBITAL CELLULITIS IS SERIOUS BUT TREATABLE EYE DISEASE

Question: Recently my 10-year-old son was hospitalized with orbital cellulitis. He had gone to bed one evening with a mild cold and headache and woke up the next morning with his right eye very red and swollen shut, a fever, and a headache. I took him to the hospital on the advice of his doctor, and he was admitted. Should I have taken him to the doctor sooner? Could this have been prevented? What exactly caused his problem?

Answer: Orbital cellulitis is a complication of a sinus infection in the ethmoid or paranasal sinuses. It is a serious medical emergency. In the era before antibiotics, about 17 percent of victims died of this disease, and 20 percent of the survivors became blind in the affected eye.

The infection starts in the ethmoid sinus and spreads into the lining of the eye socket, or orbit, through the ethmoid bone. This spongy bone serves as the front floor of the skull and the roof of the nose. In children, this bone is very thin, and the infection can spread relatively easily across it into the tissues around the eye. There a several different bacteria that can cause this infection.

The first stage of orbital cellulitis involves some mild swelling and redness of the eyelids. This is frequently associated with a fever, but not always. As the disease advances, the lids and the internal tissues around the eyeball swell to the point that the sufferer may have difficulty opening his or her eye completely. There may also be pain when the eyeball is moved as well as double vision or decreased vision. Other symptoms can include the lid swollen over the eye, an eyelid that appears shiny and is red or purple in color, and a general feeling of lack of wellness (malaise). The progression of involvement of the various eye structures may vary.

Diagnosis is usually confirmed by a CT scan or an MRI of the sinuses and the area around the eye socket. This is usually a straightforward diagnosis that a skilled practitioner can make based on the physical symptoms that I’ve mentioned. However, the scans are needed to rule out other possible diseases that could be causing -- or associated with -- the eye swelling and pain.

Treatment is aimed at aggressive management of the infection. This will not only treat the orbital cellulitis itself, but also will help prevent its spread to nearby vital structures, including the brain. There is also a risk of development of a blood clot in a major vein of the brain if this infection and swelling is not treated promptly.

As you are well aware, antibiotics are the mainstay of the treatment regimen for this disease. During hospitalization, antibiotics are usually begun intravenously. This is then followed by longer course of oral antibiotics. Most people make a full recovery with no subsequent problems. Based on what you told me, you did everything correctly. When your son got sicker, you contacted his physician and followed the instructions to go to the hospital.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.