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*The authors acknowledge the special contributions of Douglas R. Lazzaro, MD, Amy Kulak, MD, and Wayne Scott, MD, to the prior edition.
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Orbital cellulitis is an infection of the soft tissues of the orbit posterior to the orbital septum. Infection may involve any of the orbital structures, including extraocular muscles, sensory and motor nerves, and the optic nerve, and may result in abscess formation (orbital or subperiosteal abscess). Patients present with a moderate to severely inflamed, painful eye, conjunctival injection, swelling of the eyelids, and chemosis (conjunctival swelling). As infection progresses, swelling increases and the eye becomes more chemotic and proptotic. Eye movement is diminished and painful in some areas of gaze, or in severe cases, all areas of gaze (frozen globe). Patients are usually febrile and in significant pain. Orbital cellulitis most often arises as an extension of infection from the paranasal sinuses, although it may also occur as a progression of preseptal cellulitis. Causative pathogens include Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, and anaerobes (Peptostreptococcus, Bacteroides, Fusobacterium), depending on the source of infection and abscess formation. Differential diagnosis includes preseptal cellulitis, dacryocystitis, dacryoadenitis, intraocular or retrobulbar mass, and retrobulbar hemorrhage from trauma.
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