Snapshot A 6-year-old boy presents to the pediatric emergency department for eye pain. A few days prior to presentation he was in a park and had a tick bite around his right eye. He has since developed right-eye swelling and pain. Physical examination is notable for periorbital warmth and erythema that is tender to palpation. Extraocular muscle eye movements are intact, not associated with pain, and there is no associated horizontal or vertical diplopia. Introduction Definition infection of the anterior portion of the eyelid does not involve the orbit fat or other ocular structures as in orbital cellulitis considered a mild condition and is unlikely to result in serious complications Pathophysiology direct inoculation of the microorganism seen in cases of trauma and insect/animal bites contiguous spread infection involving the paranasal sinuses especially the ethmoid sinuses hematogenous spread infection involving the upper respiratory tract or middle ear Microbiology Staphylococcus aureus Streptococcus pneumoniae other streptococci anaerobes Epidemiology Incidence more common than orbital cellulitis Demographics children > adults Risk factors sinusitis focal trauma insect or animal bites Presentation Symptoms/physical exam unilateral ocular pain eyelid swelling erythema of the eyelid Imaging CT scan of the orbits and sinuses indication cases where orbital cellulitis cannot be confidently excluded Differential Orbital cellulitis differentiating factor ophthalmoplegia pain with ocular movements proptosis Dacryoadenitis differentiating factor usually just involving the conjunctiva and lacrimal glands skin around and inferior to the eye generally not affected Treatment Medical empiric antibiotics indications oral antibiotics in mild cases without signs systemic toxicity intravenous antibiotics in severely ill patients, children < 1 year of age, or in children who cannot fully cooperate during the exam (thus cannot exclude orbital cellulitis) comments trimethoprim-sulfamethoxazole or clindamycin with amoxicillin, amoxicillin-calvulanic acid, cefpodoxime, or cefdinir antibiotics are typically administered for 5-7 days blood cultures are not useful and it is difficult to obtain local cultures; therefore, antibiotics are empirically used against Staphylococcus and Streptococcus ssp. Complications Although rare, can result in orbital cellulitis orbital or subperosteal abscess cavernous sinus thrombosis meningitis brain abscess Prognosis Great with prompt treatment