Snapshot A 12-year-old boy presents to the emergency department with right eye pain. His eye pain is associated with eyelid swelling and pain with eye movements. He previously had a bacterial rhinosinusitis. Physical examination is notable for a swollen eyelid with impaired extraocular movements. Blood cultures are obtained and he is admitted to the hospital for intravenous antibiotic administration. Overview Infection involving the fat and ocular muscles in the orbit the globe of the eye is not involved Introduction Microbiology Staphylococcus aureus and streptococci (most common) Mucorales leads to mucormycosis Aspergillus spp. Pathophysiology microorganisms spread from the sinuses into the orbital cavity hematogenous spread via the valveless venous system that drains the eye cavity and maxillarry and ethmoid sinuses orbital trauma leads to direct inoculation of the microorganisms all 3 of these mechanisms lead to an inflammatory response results in mechanical compression of the ocular arteries and muscles Epidemiology Demographics more common in young children Risk factors bacterial rhinosinusitis (most common cause) ethmoid sinusitis pansinusitis ophthalmic surgery infection of the teeth, middle ear, or face orbital tauma Presentation Symptoms ocular pain also with eye movements Physical exam opthalmoplegia can lead to diplopia eyelid swelling proptosis decreased visual acuity Imaging CT scan imaging studies of choice Studies Blood cultures obtain prior to antibiotic treatment Differential Preseptal cellulitis differentiating factors no pain with eye movements no ophthalmoplegia no visual impairment Treatment Medical antibiotic therapy indication all cases of orbital cellulitis medications vancomycin and ceftriaxone vancomycin and cefotaxime Surgical surgical intervention indication intracranial complications retinal and optic nerve compression Complications Blindness Abscess formation subperiosteal orbtical Cavernous sinus thrombophlebitis Brain abscess Prognosis Good with prompt antibiotic administration