Orbital cellulitis usually begins with edema of the eyelids and rapidly progresses to ptosis, proptosis, chemosis, and diminished extraocular movements. Patients are usually febrile and acutely ill. Therapy with high-dose intravenous antibiotics is mandatory. Unless a specific pathogen can be isolated from the blood or from purulent drainage, antibiotics should cover both staphylococci and gram-negative rods. Retrograde spread along venous channels from the sinuses, the orbit, or the nose can produce septic cavernous sinus thrombophlebitis.
Patients have high fever and appear toxic.
Lid edema, proptosis, and chemosis are present. Although at first the process is usually unilateral, spread across the anterior and posterior intercavernous sinuses makes it bilateral. Patients may exhibit alterations of consciousness, and lumbar puncture may reveal inflammatory changes in the cerebrospinal fluid. CT with a contrast agent or venography may help confirm the diagnosis. High-dose intravenous antibiotics, including antistaphylococcal drugs, are mandatory.