We studied a total of 23 patients with orbital cellulitis and/or orbital abscess over a period of four years in Saudi Arabia. The study showed a high rate of abscess formation (12/23) and surgical intervention (17/23). Twelve out of 23 patients were 18 or more years of age. Furthermore, 12 of 23 (52%) patients had blind eyes on admission and remained blind after treatment, and one patient died of cavernous sinus thrombosis. Only 7/23 (30%) had a predisposing cause of primary sinus disease. This study of orbital cellulitis in a developing country presents a variation in disease pattern from previous reports and suggests that delay in the initiation of antibiotic therapy may lead to serious complications which may be life threatening. The course and outcome of orbital cellulitis may vary, depending on the predisposing factor, time of onset, associated systemic disease, or delay in initiation of treatment.