By Lauren R. Rosecan, M.D., Ph.D., F.A.C.S. –
Cellulitis is a bacterial infection of tissue that can affect both the eyes and skin. Cellulitis affecting the eyes occurs in two forms: orbital and pre-septum.
Orbital cellulitis affects the structures within the space containing the eyeball and can affect eye movement (due to swelling of the lids or eye). This form is more serious and usually calls for more aggressive treatment.
Pre-septum cellulitis is restricted to eyelid tissue and is generally less serious. The vast majority of pre-septal cellulitis cases occur in children, especially young children.
Cellulitis is frequently caused by a staph or strep infection. It is not unusual for the infection to start in the sinuses and then spread to the orbit or eyelid. Skin wounds or recent surgery (including dental surgery) can also lead to infection. It is important to clean any wounds carefully and follow any instructions your doctor or dentist may have given you for postoperative care.
One of the characteristics of cellulitis is that it spreads rapidly, which makes it a very serious infection requiring immediate medical care. Prior to the use of antibiotics to treat cellulitis, both blindness and death were common among people who contracted the infection.
If you think you or your child have cellulitis, don’t delay in seeing your doctor. Left untreated, cellulitis can permanently reduce your vision or spread into the body’s lymph system and cause more serious harm.
Cellulitis symptoms may include:
• Bulging eye
• Swelling of the eyelid or tissues around the eye
• Red eyelids
• Reduced eye movement
• Blurred vision
• Low energy
• Decreased vision
People with cellulitis may have recently had sinusitis or an upper respiratory infection.
What Causes Cellulitis?
The structure of the orbit makes that region particularly susceptible to nearby infections, particularly infections that are inclined to spread quickly. Cellulitis is most commonly caused by streptococci or staphylococci, but can also be caused by fungal infections.
Indirect causes of cellulitis (which make the eye vulnerable to a strep or staph infection) include recent surgery, bug bites, a skin wound (especially on the face) and sinusitis. Because sinusitis is more common in cold weather, cellulitis tends to occur more frequently in winter.
Cellulitis can also accompany asthma, smallpox and other systemic diseases.
For reasons that are not entirely clear, it appears that increased use of the flu vaccine has reduced the frequency of cellulitis, particularly pre-septal cellulitis.
Your doctor will gather several types of information to reach a diagnosis. Some of this will be a simple history of any recent surgery or dental work, facial or skin wounds, and respiratory or sinus infections. Your doctor will also do a basic eye examination.
In addition, determining the type of infection will most likely require some sort of lab work. If your doctor suspects pre-suptal cellulitis, he or she may wish to test samples from the nose or even the eye itself. However, if orbital cellulitis is suspected, a blood test is likely.
In some cases, your doctor may also wish to obtain a CT or other scan of the area. These images will help your doctor determine the extent of any infection in the orbit.
Pre-septal cellulitis is usually less serious than orbital cellulitis. In most cases, your doctor will prescribe an antibiotic for cellulitis. You should start to see improvement within a day or two. In fact, your doctor will probably ask for a report after two to three days, to make sure the infection is waning.
If you have a serious cellulitis infection and/or have not responded to antibiotics after a few days, you may need to be hospitalized and receive intravenous antibiotics.
Under some circumstances, your doctor may need to drain fluid. Sometimes this can be performed in your doctor’s office, but in other cases it may require surgery in a hospital or clinic setting.
Lauren R. Rosecan
M.D., Ph.D., F.A.C.S.
The Retina Institute of Florida with four offices conveniently located in Palm Beach and Martin Counties.
Toll Free Phone Number: 1-800-445-8898 Or 561-832-4411
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