Most cases of orbital cellulitis are bacterial and often involve the causative bacteria that can cause sinusitis since the direct extension is the most common mechanism due to small perforations were seen in the orbital septum. Other prospective causes include cases following ophthalmic surgery or peribulbar anesthesia, trauma or foreign body, severe dacryocystitis, or even infections of the teeth, face, or middle ear can spread and involve the orbit. ,, ĭue to its coexistence with rhinosinusitis, orbital cellulitis is most predominant in the winter months. According to some sources, 86% to 98% of cases of orbital cellulitis are found to have coexisting rhinosinusitis, specifically cases of ethmoid sinusitis are most commonly involved. This is because most cases of orbital cellulitis are preceded by bacterial rhinosinusitis or an upper respiratory infection which are most commonly seen in younger children. Overall, orbital cellulitis is much more common in younger children as opposed to older children or even adults.
However, fungal orbital cellulitis has a much slower and chronic course compared to its bacterial counterpart. Special scenarios to note are the associations of necrotizing sinusitis by mucormycosis in the diabetic patient in Ketoacidosis and Aspergillus infection of the orbit in immunosuppressed patients due to HIV infection or severely neutropenic patients. Mucormycosis and Aspergillosis species are the most common associated fungal etiologies of orbital cellulitis. One other important consideration is the involvement of fungal species in the immunocompromised patient. Specifically, Fusobacterium and Peptostreptococcal species are the most commonly associated anaerobes causing orbital cellulitis in the United States. Non-spore forming anaerobic bacteria are also associated with orbital cellulitis but at a much lower rate than the previous organisms. Influenza type B has been associated with 20% of orbital cellulitis cases associated with subperiosteal abscess formation. , 5 Haemophilus influenzae and Streptococcu s pneumoniae historically have been major components of this type of infection however, their incidence has significantly decreased since the introduction of vaccines against these organisms. The most common causative organisms are Staphylococcus and Streptococcus species, specifically Staphylococcus aureus and group A Streptococcus, with increasing incidence of MRSA (methicillin-resistant Staphylococcus aureus) being of great concern. Īlthough periorbital cellulitis is a much more common entity, especially in children, it is important to recognize the differences of orbital cellulitis as its complications are much more severe and can become life-threatening. In distinction, preseptal (periorbital) cellulitis is an infection anterior to the orbital septum, mainly involving the eyelids. These contents include the periorbital fat and extra-ocular muscles, but exclude the involvement of the globe itself. Orbital cellulitis is an infection causing inflammation of the orbital contents posterior to the orbital septum. Identify the importance of improving care coordination among the interprofessional team to enhance delivery of care for patients affected by orbital cellulitis.Outline the differences between preseptal and orbital inflammation during the history and physical examination of patients affected by orbital cellulitis.Describe the pathophysiology of orbital cellulitis.
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