The signs of orbital cellulitis include red and swollen lids and conjunctiva, as seen in the top photograph. Characteristically, ocular motility is impaired and there is pain on eye movement, as seen in the bottom photograph. Because the infection is posterior, the periorbital area may seem relatively uninflamed. The eye may protrude forward because of orbital swelling due to inflammation (proptosis), as seen in the middle photograph. Often the patient with orbital cellulitis will have fever and leukocytosis. Optic nerve involvement is signaled by decreased vision, an afferent pupillary defect, and optic disc edema. Meningitis can result from spreading along the optic nerve.