Cellulitis of the Eye in Children

What is cellulitis of the eyelid or eye socket in children?

Cellulitis is a serious type of infection and inflammation. It can occur in different parts of the body. When it occurs in the eyelid and tissues in the front part of the eye area, it’s called preseptal cellulitis. When it occurs in tissues behind and around the eye (orbit), it’s called orbital cellulitis. Both of these conditions are serious. If your child has either one, they need medical treatment right away.

What causes cellulitis of the eyelid or eye socket in a child?

The most common cause of cellulitis of the eyelid or eye socket is an infection with bacteria. Often the exact bacteria are hard to identify. Common bacteria that cause cellulitis of the eye socket include:

  • Staphylococcus aureus
  • Streptococcus pyogenes
  • Haemophilus influenzae

The bacteria can get into the eye area in many different ways. The 2 most common ways are:                                                                                                                                                                 

  • Injury. An injury to the area around the eye can lead to infection from the bacteria.
  • Infection near the eye. Most often, the infection begins in the sinuses. The sinuses are air-filled areas formed by the bones of the face. There are sinuses above and below the eye area.

Which children are at risk for cellulitis of the eyelid or eye socket?

A child is more at risk of cellulitis of the eyelid or eye socket if they've had either of these:

  • An injury to the eye area
  • A sinus infection

What are the symptoms of cellulitis of the eyelid or eye socket in a child?

Symptoms of cellulitis of the eyelid or eye socket can occur a bit differently in each child.

The symptoms of preseptal cellulitis can include:

  • Swelling of the upper and lower eyelid
  • Redness of the upper and lower eyelid
  • Skin feels warm in the eye area
  • Pain in the eye area
  • Fever

The eyeball is often not affected and will look normal. The eyes also will move normally.

The symptoms of orbital cellulitis can include:

  • Swelling of the upper and lower eyelid
  • Tissues in the orbit that are swollen and bulge
  • Eye that looks red and may bulge
  • Trouble moving the eye
  • Pain in the eye area
  • Decrease in vision or color vision
  • The pupil reacts less than normal
  • Fever

The symptoms of cellulitis of the eyelid or eye socket can seem like other health conditions. Make sure your child sees their healthcare provider right away for a diagnosis.

How is cellulitis of the eyelid or eye socket diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. They will give your child a physical exam. Your child may also have tests, such as:

  • Blood tests. These are done to check for signs of infection.
  • CT scan. This test uses a series of X-rays and a computer to make detailed images of the body. A CT scan can show bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays. This scan can show how much of the eye area is infected.
  • MRI. This test uses large magnets and a computer to make detailed images of tissues in the body. This scan can also help show how much of the eye area is infected.

How is cellulitis of the eyelid or eye socket treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. The 2 conditions may be treated differently:

Treatment for preseptal cellulitis. This is most often done with antibiotic medicine taken by mouth or by a shot (injection). Your child will need to see the healthcare provider for follow-up care. This is to make sure the infection is going away, and not getting worse. Sometimes your child may need to stay in the hospital to get antibiotics by IV (intravenous) line into a vein.

Treatment for orbital cellulitis. Your child may need to see a special eye care provider (ophthalmologist) or an ear, nose, and throat specialist (ENT or otolaryngologist). Treatment may include:

  • Antibiotics through an IV. This is done in the hospital. The medicine is given through a tube (catheter) into a vein. Your child will need to stay in the hospital for 1 or more nights.
  • Surgery. This may be done to drain the sinuses or any abscesses of the eye socket. An abscess is a pocket of infection.

What are possible complications of cellulitis of the eyelid or eye socket in a child?

Possible complications include:

  • Infection of the lining covering the brain and the spinal cord (meningitis)
  • Vision loss
  • Brain abscess
  • Brain damage due to abscess

When should I call my child’s healthcare provider?

Call your child’s healthcare provider right away if your child has symptoms of cellulitis of the eyelid or eye socket. If your child is being treated for cellulitis of the eyelid or eye socket, call the healthcare provider if the symptoms are getting worse, or your child has new symptoms.

Key points about cellulitis of the eyelid or eye socket in children

  • Cellulitis is a serious type of infection and inflammation. When it occurs in the eyelid and tissues in the front part of the eye area, it’s called preseptal cellulitis. When it occurs in tissues behind and around the eye (orbit), it’s called orbital cellulitis.
  • Both of these conditions need medical treatment right away.
  • The most common cause of cellulitis of the eyelid or eye socket is an infection with bacteria.
  • Symptoms include swelling and redness of the upper and lower eyelid, and pain in the eye area.
  • Treatment is done with antibiotic medicine. Your child may need to spend time in the hospital. Surgery may be done to drain areas of infection.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.