Orbital Cellulitis Diagnosis and Management

Clinical Features and Investigations

The American College of Radiology recommends contrast-enhanced CT of orbits and sinuses as the first-line imaging to identify orbital abscess, subperiosteal abscess, and source of infection, typically sinusitis, due to its speed, ability to demonstrate bony anatomy and sinus disease, and availability in emergency settings 2, 3
Visual acuity must be documented immediately, as vision loss can occur from optic nerve compression or ischemia, and any vision worse than 20/40 mandates urgent specialist evaluation, according to Praxis Medical Insights 1

Immediate ophthalmology consultation is required for all suspected orbital cellulitis, and visual acuity testing should be performed, with any vision worse than 20/40 requiring urgent evaluation 1
The American College of Radiology suggests that CT is preferred over MRI initially because it is faster and better demonstrates bony anatomy and sinus disease 2, 3
Surgical intervention is required if an orbital or subperiosteal abscess is identified on CT, or if there is vision deterioration despite 24-48 hours of IV antibiotics, optic nerve compromise, a large abscess, complete ophthalmoplegia, or frontal sinusitis 2, 3