**27. Orbital and peri-orbital cellulitis as a cause of endogenous endophthalmitis**

Orbital and peri-orbital cellulitis have been reported as causes of endogenous endophthal‐ mitis. [8, 37] Facial cellulitis is rarely reported as a focus of infection leading to endogenous endophthalmitis. Facial cellulitis usually appears more rapidly than other deep infections, so treatment is required early on. However, facial cellulitis can be a direct or indirect causa‐ tive infection. The indirect pathway involves distant spread through the blood stream via the internal jugular vein. Microorganisms are then able to spread through the heart to the internal carotid artery and ophthalmic artery. Furthermore, they can follow a retrograde pathway toward the cavernous sinus of the skull, establishing thrombophlebitis in the facial vessels. These anatomical characteristics explain how facial cellulitis can be a primary infec‐ tion site of endogenous endophthalmitis. Kang et al, [8] reported a case of 51-year-old un‐ conscious woman presenting with fever, facial swelling, and decreased VA secondary to facial cellulitis, endogenous endophthalmitis and end-stage renal disease. These authors re‐ ported successful treatment with intra-vitreal (Vancomycin, Ceftazidime) and intravenous antibiotics (Vancomycin, Meropenem). The authors reported a successful outcome in their patient's bilateral endogenous endophthalmitis following timely treatment with the intra-vi‐ treal as well as systemic antibiotic administration.
