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{{Orbital cellulitis}}
{{Orbital cellulitis}}
{{CMG}}; {{AE}} {{Ochuko}} {{TarekNafee}}
{{CMG}}; {{AE}} {{Ochuko}}; {{TarekNafee}}


==Overview==
==Overview==
Common causes of orbital cellulitis are infections with either ''[[Staphylococcus aureus]]'', ''[[Streptococcus pneumoniae]]'', ''[[Haemophilus influenzae]]'', or ''beta-hemolytic streptococci''.
Orbital cellulitis occurs most commonly from typical [[bacterial infections]]. In some cases, [[Mycobacterium|mycobacteria]] or [[Mycosis|mycosis]] may also be implicated. The most common underlying condition is [[Sinusitis|ethmoid sinusitis]], which has been reported in 90-98% of orbital cellulitis cases. The most commonly reported [[Pathogen|pathogens]] are [[Staphylococcus aureus|''Staphylococcus aureus'']], [[Streptococcus|''Streptococcus spp.'']], and [[Haemophilus influenzae|''Haemophilus influenzae'']]. With the rise of [[Antibiotic resistance|microbial resistance]], [[Methicillin-resistant staphylococcus aureus|methicillian-resistant ''Staphylococcus aureus'' (MRSA)]] must be considered as a potential cause and correlated with geographic [[prevalence]]. Though some causes may be uncommon, orbital cellulitis is a medical emergency and all [[etiologies]] must be considered.<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name=merckmanualorbitalcellulitis> Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis</ref><ref name=eyewikiorbitalcellulitis> American Academy of Ophthalmology Eyewiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis#Etiology</ref><ref name="pmid16874168">{{cite journal| author=Nageswaran S, Woods CR, Benjamin DK, Givner LB, Shetty AK| title=Orbital cellulitis in children. | journal=Pediatr Infect Dis J | year= 2006 | volume= 25 | issue= 8 | pages= 695-9 | pmid=16874168 | doi=10.1097/01.inf.0000227820.36036.f1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16874168  }} </ref><ref name="pmid22346113">{{cite journal| author=Chaudhry IA, Al-Rashed W, Arat YO| title=The hot orbit: orbital cellulitis. | journal=Middle East Afr J Ophthalmol | year= 2012 | volume= 19 | issue= 1 | pages= 34-42 | pmid=22346113 | doi=10.4103/0974-9233.92114 | pmc=3277022 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346113  }} </ref>


==Causes==
==Causes==
Orbital cellulitis occurs most commonly from bacterial infection. In some cases, mycobacteria or fungal organisms may also be implicated.<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name=merckmanualorbitalcellulitis> Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis</ref><ref name=eyewikiorbitalcellulitis> American Academy of Ophthalmology Eyewiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis#Etiology</ref> Difficulty arises in identifying a specific organism due to challenges in culturing the retroseptal orbital region. Blood cultures are typically positive in 4% of patients with orbital cellulitis with the highest reported rate of positive result of 31%. Mucosal swabs of nasal and preseptal mucosa show a slightly higher positive culture result of 51%; however, their accuracy is a topic of debate considering the normal flora in these tissues. The most likely source of a positive culture in confirmed orbital cellulitis patients is a surgical specimen from an abscess or nasal sinus aspirate. This procedure is not routinely performed on all patients with orbital cellulitis, thus this represents a subsection of the population.<ref name="pmid21232022">{{cite journal| author=Baring DE, Hilmi OJ| title=An evidence based review of periorbital cellulitis. | journal=Clin Otolaryngol | year= 2011 | volume= 36 | issue= 1 | pages= 57-64 | pmid=21232022 | doi=10.1111/j.1749-4486.2011.02258.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21232022  }} </ref>  
 
Orbital cellulitis occurs most commonly from [[bacterial infection]]. In some cases, [[mycobacterial]] or [[fungal]] infections are observed.<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name=merckmanualorbitalcellulitis> Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis</ref><ref name=eyewikiorbitalcellulitis> American Academy of Ophthalmology Eyewiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis#Etiology</ref> Difficulty arises in identifying a specific [[organism]] due to challenges in culturing the [[Orbit (anatomy)|retroseptal orbital region]].<ref name="pmid21232022">{{cite journal| author=Baring DE, Hilmi OJ| title=An evidence based review of periorbital cellulitis. | journal=Clin Otolaryngol | year= 2011 | volume= 36 | issue= 1 | pages= 57-64 | pmid=21232022 | doi=10.1111/j.1749-4486.2011.02258.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21232022  }} </ref>


===Cause by Pathogen===
===Cause by Pathogen===
The most commonly reported pathogens, regardless of culturing method were ''Staphylococcus aureus'', ''Streptococcus spp.'', and ''Haemophilus influenza''. With the rise of microbial resistance in more recent years, Methicillian-Resistant Staphylococcus Aureus (MRSA) must be considered as a potential cause and correlated with geographic prevalence. MRSA has been cultured in as high as 73% of cases in a retrospective study of orbital cellulitis patients. Alternatively, with the dissemination of *Haemophilus influenza type b (Hib)* vaccine, the incidence of *Haemophilus spp.* caused orbital cellulitis has decreased significantly.<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref> It has also been reported that in patients above the age of 15-16, cultures are more likely to grow a mixed, polymicrobial flora with both aerobic and anaerobic bacteria.<ref name=merckmanualorbitalcellulitis> Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis</ref><br>
Common [[bacterial]] causes of orbital cellulitis include:<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name=merckmanualorbitalcellulitis> Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis</ref>
*''[[Staphylococcus aureus]]''
*''[[Streptococcus|Streptococcus spp.]]''
*''[[Haemophilus influenzae]]''
** With the dissemination of [[Haemophilus influenzae Type b (Hib) Vaccine (patient information)|Haemophilus influenza type b (Hib) vaccine]], the [[incidence]] of [[Haemophilus influenzae|''Haemophilus influenzae'']]-caused orbital cellulitis has decreased significantly.
*[[Methicillin-resistant staphylococcus aureus|Methicillin-resistant ''Staphylococcus aureus'' (MRSA)]]
**Rise in [[Antibiotic resistance|microbial resistance]], [[Methicillin-resistant staphylococcus aureus|MRSA]] must be considered as a potential cause and correlated with geographic [[prevalence]].
*[[Aerobic organism|Aerobic]] and [[Anaerobic organism|anaerobic bacteria]]


It is important to note that, although rare, in immunocompromised patients we begin to see an increase in incidence of fungal and mycobacterial sources of infections. The most common fungal infections encountered in this population were Mucormycosis and Aspergilliosis. ''Mycobacterium tuberculosis'' has also been reported in immunocompromised patients in endemic regions.<ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref>
In [[Immunodeficiency|immunocompromised]] patients, additional causes may include:<ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref>
*[[Mycosis|Fungal]] infection
**[[Zygomycosis|Mucormycosis]]
**[[Aspergillosis|Aspergilliosis]]
*[[Mycobacterium|Mycobacterial]] infection
**''[[Mycobacterium tuberculosis]]''


===Cause by Etiology===
===Cause by Etiology===
Another effective way to categorize the causes of orbital cellulitis is according to the underlying etiology or source of infection. By far, the most common underlying condition is [[Sinusitis|ethmoid sinusitis]]. It has been reported as the cause in 90-98% of orbital cellulitis cases.<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid16874168">{{cite journal| author=Nageswaran S, Woods CR, Benjamin DK, Givner LB, Shetty AK| title=Orbital cellulitis in children. | journal=Pediatr Infect Dis J | year= 2006 | volume= 25 | issue= 8 | pages= 695-9 | pmid=16874168 | doi=10.1097/01.inf.0000227820.36036.f1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16874168  }} </ref><ref name="pmid22346113">{{cite journal| author=Chaudhry IA, Al-Rashed W, Arat YO| title=The hot orbit: orbital cellulitis. | journal=Middle East Afr J Ophthalmol | year= 2012 | volume= 19 | issue= 1 | pages= 34-42 | pmid=22346113 | doi=10.4103/0974-9233.92114 | pmc=3277022 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346113  }} </ref>
Based on [[etiology]], the most common underlying condition causing orbital cellulitis is [[Sinusitis|ethmoid sinusitis]], which occurs in 90-98% of cases.<ref name="pmid15318671">{{cite journal| author=Hasanee K, Sharma S| title=Ophthaproblem. Orbital cellulitis. | journal=Can Fam Physician | year= 2004 | volume= 50 | issue=  | pages= 359, 365, 367 | pmid=15318671 | doi= | pmc=2214559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15318671  }} </ref><ref name="pmid16874168">{{cite journal| author=Nageswaran S, Woods CR, Benjamin DK, Givner LB, Shetty AK| title=Orbital cellulitis in children. | journal=Pediatr Infect Dis J | year= 2006 | volume= 25 | issue= 8 | pages= 695-9 | pmid=16874168 | doi=10.1097/01.inf.0000227820.36036.f1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16874168  }} </ref><ref name="pmid22346113">{{cite journal| author=Chaudhry IA, Al-Rashed W, Arat YO| title=The hot orbit: orbital cellulitis. | journal=Middle East Afr J Ophthalmol | year= 2012 | volume= 19 | issue= 1 | pages= 34-42 | pmid=22346113 | doi=10.4103/0974-9233.92114 | pmc=3277022 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22346113  }} </ref> Additional causes based on etiology include:<ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name="pmid21232022">{{cite journal| author=Baring DE, Hilmi OJ| title=An evidence based review of periorbital cellulitis. | journal=Clin Otolaryngol | year= 2011 | volume= 36 | issue= 1 | pages= 57-64 | pmid=21232022 | doi=10.1111/j.1749-4486.2011.02258.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21232022  }} </ref>
Though some causes of orbital cellulitis may be uncommon, it is pertinent to consider all possible etiologies and associated conditions' most common pathogens according to the clinical scenario:<ref name="pmid22224014">{{cite journal| author=Lam Choi VB, Yuen HK, Biswas J, Yanoff M| title=Update in pathological diagnosis of orbital infections and inflammations. | journal=Middle East Afr J Ophthalmol | year= 2011 | volume= 18 | issue= 4 | pages= 268-76 | pmid=22224014 | doi=10.4103/0974-9233.90127 | pmc=3249811 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22224014  }} </ref><ref name="pmid21232022">{{cite journal| author=Baring DE, Hilmi OJ| title=An evidence based review of periorbital cellulitis. | journal=Clin Otolaryngol | year= 2011 | volume= 36 | issue= 1 | pages= 57-64 | pmid=21232022 | doi=10.1111/j.1749-4486.2011.02258.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21232022  }} </ref><br>
*'''[[Sinusitis]]''':  
*'''Sinusitis''': ''Staphylococcus aureus, Streptococcus spp., H. influenza''
**[[Staphylococcus aureus|''Staphylococcus aureus'']]
*'''Dacryocystitis, dacryoadenitis, and other lacrimal duct abnormalities''': ''Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenza''
**[[Streptococcus|''Streptococcus spp.'']]
*'''Traumatic/Foreign body''': ''Staphyloccus aureus, Streptococcus epidermidis, Enterococcus spp., Escherichia coli, Eikenella spp.''
**[[Haemophilus influenzae|''Haemophilus influenzae'']]
*'''Spread from superficial infections of the face or adjacent soft tissue''': ''Staphylococcus aureus, Streptococcus pyogenes''
*'''[[Dacryocystitis]], [[dacryoadenitis]], and other [[lacrimal duct]] abnormalities'''
*'''Dental caries/abscess''': ''Bacteroides spp.'' anaerobes, and gram negative rods
**[[Staphylococcus aureus|''Staphylococcus aureus'']]
*'''Iatrogenic/post-surgical procedures''': ''Staphylococcus aureus, Streptococcus spp.''
**[[Streptococcus pneumoniae|''Streptococcus pneumoniae'']]
*'''Immunocompromised patient''': ''Mucormycosis, Aspergilliosis, M.Tuberculosis''
**[[Streptococcus pyogenes|''Streptococcus pyogenes'']]
*'''Diabetic patients with or without history of diabetic ketoacidosis''': ''Pseudomonas aeruginosa, Klebsiella pneumoniae''
**[[Haemophilus influenzae|''Haemophilus influenzae'']]
*'''Traumatic/[[Foreign body|Foreign body]]''':  
**[[Staphylococcus aureus|''Staphylococcus aureus'']]
**[[Staphylococcus epidermidis|''Staphylococcus epidermidis'']]
**[[Enterococcus|Enterococcus spp.]]
**[[Escherichia coli|''Escherichia coli'']]
**[[Eikenella|''Eikenella spp.'']]
*'''Spread from superficial [[infections]] of the face or adjacent [[soft tissue]]''':  
**[[Staphylococcus aureus|''Staphylococcus aureus'']]
**[[Streptococcus pyogenes|''Streptococcus pyogenes'']]
*'''[[Dental caries|Dental caries]]/[[Tooth abscess|Tooth abscess]]''':  
**[[Bacteroides|''Bacteroides spp.'']]
**[[Anaerobic organism|anaerobes]]
**[[Gram-negative bacteria|gram negative]] rods
*'''Iatrogenic/post-surgical procedures''':  
**[[Staphylococcus aureus|''Staphylococcus aureus'']]
**[[Streptococcus|''Streptococcus spp.'']]
*'''[[Immunocompromised]] patient''':  
**[[Zygomycosis|''Mucormycosis'']]
**''[[Aspergillosis|Aspergilliosis]]''
**''[[Mycobacterium tuberculosis]]''
*'''[[Diabetic]] patients with or without history of [[diabetic ketoacidosis]]'''
**[[Pseudomonas aeruginosa|''Pseudomonas aeruginosa'']]
**[[Klebsiella pneumoniae|''Klebsiella pneumoniae'']]


===Cause by Organ System===
===Cause by Organ System===
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| '''Ophthalmologic'''
|bgcolor="Beige"| [[Blepharoplasty]], [[dacryocystitis]], [[dacryocystorhinostomy]], [[blepharoplasty|eyelid surgery]], [[eye surgery|ophthalmic surgery]], [[orbital decompression]], [[blowout fracture|orbital fracture]], [[osteomyelitis|osteomyelitis of the orbital bones]], [[radial keratotomy]], [[eye surgery|retinal surgery]], [[strabismus surgery]]
|bgcolor="Beige"| [[Blepharoplasty]], [[dacryocystitis]], [[dacryocystorhinostomy]], [[blepharoplasty|eyelid surgery]], [[eye surgery|ophthalmic surgery]], orbital decompression, [[blowout fracture|orbital fracture]], [[osteomyelitis|osteomyelitis of the orbital bones]], [[radial keratotomy]], [[eye surgery|retinal surgery]], [[strabismus surgery]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
{{columns-list|3|
{{columns-list|
*[[Aeromonas hydrophila]]  
*[[Aeromonas hydrophila]]  
*[[Anaerobes]]
*[[Anaerobes]]
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{{Reflist|2}}
{{Reflist|2}}


{{WH}}
{{WS}}
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Bacterial diseases]]
[[Category:Ophthalmology]]
[[Category:Ophthalmology]]
[[Category:Crowdiagnosis]]
{{WH}}
{{WS}}

Latest revision as of 23:26, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]; Tarek Nafee, M.D. [3]

Overview

Orbital cellulitis occurs most commonly from typical bacterial infections. In some cases, mycobacteria or mycosis may also be implicated. The most common underlying condition is ethmoid sinusitis, which has been reported in 90-98% of orbital cellulitis cases. The most commonly reported pathogens are Staphylococcus aureus, Streptococcus spp., and Haemophilus influenzae. With the rise of microbial resistance, methicillian-resistant Staphylococcus aureus (MRSA) must be considered as a potential cause and correlated with geographic prevalence. Though some causes may be uncommon, orbital cellulitis is a medical emergency and all etiologies must be considered.[1][2][3][4][5][6]

Causes

Orbital cellulitis occurs most commonly from bacterial infection. In some cases, mycobacterial or fungal infections are observed.[1][2][3][4] Difficulty arises in identifying a specific organism due to challenges in culturing the retroseptal orbital region.[7]

Cause by Pathogen

Common bacterial causes of orbital cellulitis include:[1][2][3]

In immunocompromised patients, additional causes may include:[2]

Cause by Etiology

Based on etiology, the most common underlying condition causing orbital cellulitis is ethmoid sinusitis, which occurs in 90-98% of cases.[1][5][6] Additional causes based on etiology include:[2][7]

Cause by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental Dental infection, tooth abscess
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat Ethmoid sinusitis, otitis media, sinusitis
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic Peribulbar anesthesia, surgical trauma
Infectious Disease Aeromonas hydrophila, anaerobes, arcanobacterium, aspergillosis, aspergillus, bacterial rhinosinusitis, bacteroides, beta-hemolytic streptococci, dacryocystitis, dental infection, eikenella corrodens, enterococcus, ethmoid sinusitis, haemophilus influenzae, haemophilus parainfluenzae, infected mucocele, klebsiella pneumoniae, moraxella catarrhalis, MRSA, MSSA, mucor, mucorales, mucormycosis, mycobacterium tuberculosis, neisseria gonorrhea, osteomyelitis of the orbital bones, otitis media, peptostreptococcus, pseudomonas aeruginosa, rothia mucilaginosa, sinusitis, staphylococcus aureus, streptococcus anginosus, streptococcus milleri, streptococcus pneumoniae, streptococcus pyogenes, streptococcus, tooth abscess, varicella
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic Blepharoplasty, dacryocystitis, dacryocystorhinostomy, eyelid surgery, ophthalmic surgery, orbital decompression, orbital fracture, osteomyelitis of the orbital bones, radial keratotomy, retinal surgery, strabismus surgery
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Mycobacterium tuberculosis
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma Orbital fracture, trauma
Urologic No underlying causes
Miscellaneous Foreign body, phlebitis of the facial veins


Causes in Alphabetical Order

References

  1. ↑ 1.0 1.1 1.2 1.3 Hasanee K, Sharma S (2004). "Ophthaproblem. Orbital cellulitis". Can Fam Physician. 50: 359, 365, 367. PMC 2214559. PMID 15318671.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Lam Choi VB, Yuen HK, Biswas J, Yanoff M (2011). "Update in pathological diagnosis of orbital infections and inflammations". Middle East Afr J Ophthalmol. 18 (4): 268–76. doi:10.4103/0974-9233.90127. PMC 3249811. PMID 22224014.
  3. ↑ 3.0 3.1 3.2 Merck Manual Professional Version (2016)https://www.merckmanuals.com/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis
  4. ↑ 4.0 4.1 American Academy of Ophthalmology Eyewiki (2015)http://eyewiki.aao.org/Orbital_Cellulitis#Etiology
  5. ↑ 5.0 5.1 Nageswaran S, Woods CR, Benjamin DK, Givner LB, Shetty AK (2006). "Orbital cellulitis in children". Pediatr Infect Dis J. 25 (8): 695–9. doi:10.1097/01.inf.0000227820.36036.f1. PMID 16874168.
  6. ↑ 6.0 6.1 Chaudhry IA, Al-Rashed W, Arat YO (2012). "The hot orbit: orbital cellulitis". Middle East Afr J Ophthalmol. 19 (1): 34–42. doi:10.4103/0974-9233.92114. PMC 3277022. PMID 22346113.
  7. ↑ 7.0 7.1 Baring DE, Hilmi OJ (2011). "An evidence based review of periorbital cellulitis". Clin Otolaryngol. 36 (1): 57–64. doi:10.1111/j.1749-4486.2011.02258.x. PMID 21232022.


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