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This is a potentially sight-threatening condition and the patient should be referred to the ophthlamologists for further management. Sight loss may result from central retinal artery occlusion or optic nerve inflammation.  In adults the most common infection are Staphylococcus aureus, Streptoccocus pyogenes or  Streptoccus penumoniae. In children , it is often secondary to infection in the adjacent sinuses and  Haemophilia influzae is an important pathogen. Presentation: Severe pain Tense and red orbit with lid closure Pyrexia  Examination Intense swelling of the lids Proptosis Congestion of the conjunctival and episcleral vessels Chemosis (swollen conjunctiva) Double vision may occur due to poor eye movement in  a congested orbit. Treatment: Refer to the ophthalmologist within 24 hours. Treatment require systemic antibiotics and analgesia. Figure 1. This child has a typical appearance of orbital cellulitis with swollen and tense right  eyelid and difficulty in openin the eye. Treatment should involve admission with intravenous antibiotics. Figure 2. This is the CT scan of a 7 year-old patient with a right orbital cellulitis. Note the  presence of opacity in the right ethmoid sinus. The orbital cellulitis is caused by  the spread of infection from ethmoid sinusitis. Return to swollen lids