Orbital Cellulitis is usually secondary to sinusitis; which signs are commonly observed?

• A. Usually secondary to sinusitis; decreased vision, pain with ocular movement, proptosis.
• B. Primarily conjunctival infection with mild irritation.
• C. Direct trauma to the orbit without sinus involvement.
• D. Allergic conjunctivitis with eyelid swelling

Answer: (A)

Orbital cellulitis is an infection located behind the orbital septum, most often arising from sinusitis, especially in children. Because the infection involves the contents of the orbit, it typically causes signs that reflect deep orbital inflammation: fever with eyelid swelling, and importantly, pain with eye movement due to inflamed extraocular muscles, restricted or painful extraocular movements, proptosis (eye protrusion), and often decreased visual acuity. These findings point to involvement of the orbit itself rather than just the surface structures.

If the issue were limited to the conjunctiva, you’d expect mainly conjunctival irritation with redness, not painful eye movements or proptosis. Direct trauma can cause orbital symptoms, but it’s not the usual route when sinusitis is the source. Allergic conjunctivitis produces itchiness and swelling without the deep orbital signs like impaired motility or proptosis. The combination of decreased vision, pain with ocular movement, and proptosis best fits orbital cellulitis linked to sinusitis.