Periorbital and orbital cellulitis in adults

ObjectiveThe pathogenesis and management of periorbital cellulitis (POC) and orbital cellulitis (OC) is distinct in the adult population. We evaluated the clinical features, radiological characteristics, etiologies and management of hospitalized adults with POC and OC.MethodsA retrospective chart review of patients ≥18 years of age, hospitalized with POC and OC over a 20-year period.ResultsThe charts of 91 patients were identified, of whom 75 were diagnosed with POC and 16 with OC. No age or gender preference was noted in either group (P = 0.149). The most common etiology of OC was infected scleral buckle or orbital implant (43.7%) followed by sinusitis (18.8%). Both were significantly more prevalent in the OC group than in the POC group. In the POC group, skin infection was the most common etiology (33.3%), followed by dacryocystitis (22.7%). Twelve patients (75%) with OC and 12 patients (16%) with POC underwent surgical drainage of their infection (P = 0.001).ConclusionPOC and OC in adults have different distributions, predisposing factors and management than in children. The patient's medical history is of crucial importance, as it may help diagnose the entity. External periocular etiologies, such as skin infection, dacryocystitis, conjunctivitis, insect bite and allergic reaction causes POC and very rarely become OC, whereas sinusitis and infected orbital implants are a significant cause for OC. An infected implant is a unique cause of OC and high suspicion of orbital involvement should be raised in any sign of infection in these patients.