By Alon Kahana, MD, PhD (University of Michigan)

Treatment of orbital cellulitis depends on the symptoms, clinical exam findings and radiologic findings on CT or MRI scan. In many cases, intravenous antibiotics are used to initiate treatment in an ER or hospital setting, followed by oral antibiotics for a pre-prescribed duration. However, in some cases the orbit contains an abscess, where bacteria can essentially hide from the antibiotics. In those cases, an orbital or sinus surgeon needs to enter the orbit surgically to drain the abscess and possibly place a drain to prevent a recurrence of the abscess. Antibiotic treatment would occur concomitantly.

Orbital abscesses can be very dangerous. Because the orbit is a small enclosed compartment, the abscess can increase pressure on the orbital tissues and cause damage to the eye and/or optic nerve – causing blindness! Also, because the orbit is so close to the brain, with direct conduits through bone into the brain cavity (cranium), orbital cellulitis and abscesses can spread and affect the brain. Therefore, treatment of orbital cellulitis is considered an emergency.