General: Children typically suffer from more severe infections than adults, and they usually require hospitalization until the infection is under control. Infection usually improves rapidly with antibiotic or antifungal treatment. Intravenous antibiotics or antifungals are used to stop the spread of infection and prevent damage to the optic nerve. Different antibiotics/antifungals are prescribed depending on the organism that causes the infection. Depending on the severity of the infection, treatment can last anywhere from six hours to several days. If the infection has spread to the sinus cavity close to the brain, surgery may be necessary.
Cefuroxime (Ceftin®): One of the most commonly prescribed antibiotics is cefuroxime (Ceftin®). Cefuroxime has been administered intravenously to treat infections caused by Proteus mirabilis, H. influenzae, E. coli, Klebsiella pneumoniae and Moraxella catarrhalis.
Ceftriaxone and clindamycin: Ceftiaxone and clindamycin have been used concomitantly to treat bacterial infections associated with ocular cellulitis. Treatment generally lasts from six hours to three days.
Nafcillin (Unipen®): Nafcillin (Unipen®) has been used to treat infections caused by Staphylococcus or Streptococcus.
Ticarcillin (Ticar®): Ticarcillin (Ticar®) has been used to treat bacterial infections caused by many different organisms, including H. influenzae and S. aureus.
Antifungals: Antifungals like amphotericin B (AmBisome®) are used to treat fungal infections that cause ocular cellulitis. The medication is administered intravenously. In severe cases, antifungal treatment may begin before a diagnosis is confirmed.
Nasal decongestants: Nasal decongestants like phenylephrine (Neo-Synephrine®) or oxymetazoline (Afrin®, Sinarest® or Allerest®) have been used to treat orbital cellulitis that is caused by sinusitis. Nasal decongestants may help open the sinuses and aid with drainage.
Surgery: If the infection has spread to the sinus cavity close to the brain, surgery may be necessary. An ophthalmologist or otolaryngologist will surgically drain the eye sockets and/or sinus cavities.
Good scientific evidence
Iodine: Povidone-iodine solutions have been used to manage childhood bacterial conjunctivitis, and may be as effective as other anti-bacterial solutions such as neomycin-polymyxin B-gramicidin. This is not an effective treatment for viral conjunctivitis. Medical supervision is recommended.
Reactions to iodine can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis or tuberculosis. Use cautiously when applying to the skin because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
Eyebright: Eyebright has been used in ophthalmic solutions for centuries, to manage multiple eye conditions. Beyond historical and anecdotal reports, one controlled study in children and one open label trial in adults have investigated eyebright for conjunctivitis. There is insufficient safety data for this indication, with concerns regarding potential contamination of products and an increased risk of infection. There is currently insufficient scientific evidence to recommend for or against the use of eyebright in the treatment of conjunctivitis.
Avoid if allergic to eyebright, any of its constituents or members of the Scrophulariaceae family. Use cautiously as an eye treatment, particularly homemade preparations, due to the risk of infection if not sterile. Use cautiously with diabetes and drugs that are broken down by the liver. Avoid if pregnant or breastfeeding.
The Haemophilus influenzae B (HiB) vaccine can effectively prevent nearly all Haemophilus infections, which often lead to ocular cellulitis. H. influenzae is a widespread bacteria that is present in about 75% of people. However, individuals who have healthy immune systems do not experience symptoms of the disease. Therefore, children (up to 12 months old) and individuals who have compromised immune systems typically experience the most benefit from the vaccine. The patient receives one immunization, administered intravenously, during his/her lifetime.
Proper evaluation and early treatment of sinus, dental or other infections may prevent the spread of an infection to the eyes.