Periorbital cellulitis
Periorbital cellulitis, or preseptal cellulitis, is an inflammation and infection of the eyelid and portions of skin around the eye anterior to the orbital septum.
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It must be differentiated from orbital cellulitis, which is an emergency and requires intravenous antibiotics.
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Periorbital cellulitis must be differentiated from orbital cellulitis , which is an emergency and requires intravenous (IV) antibiotics.
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Patients with periorbital cellulitis do not have proptosis, ophthalmoplegia, pain on eye movement, or loss of vision.
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patients with periorbital cellulitis do not have bulging of the eye ( proptosis ), limited eye movement ( ophthalmoplegia ), pain on eye movement, or loss of vision
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It may be caused by breaks in the skin around the eye, sinusitis, or spread of infection through the blood.
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It may be caused by breaks in the skin around the eye, and subsequent spread to the eyelid; infection of the sinuses around the nose ( sinusitis ); or from spread of an infection elsewhere through the blood.
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Common causes include Staphylococcus aureus, Streptococcus pneumoniae, other streptococci, and anaerobes.
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Staphylococcus aureus , Streptococcus pneumoniae , other streptococci , and anaerobes are the most common causes
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The Haemophilus influenzae vaccine has dramatically decreased the incidence.
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The advent of the Haemophilus influenzae vaccine has dramatically decreased the incidence.
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Affected individuals may experience swelling, redness, discharge, pain, shut eye, conjunctival infection, mild fever, slightly blurred vision, teary eyes, and some reduction in vision.
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Affected individuals may experience: swelling, redness, discharge, pain, shut eye, conjunctival infection, fever (mild), slightly blurred vision, teary eyes, and some reduction in vision.
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Typical signs include periorbital erythema, induration, tenderness and warmth.
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Typical signs include periorbital erythema, induration, tenderness and warmth.
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Blood work (CBC) is done to rule out infectious cause.
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Tests include blood work (CBC) to rule out infectious cause.
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Imaging tests include CT scan, x-ray of the anterior skull, MRI scan, and soft tissue ultrasound.
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Also perform a CT scan, x ray of the anterior skull to view the sinuses, MRI scan and finally a soft tissue ultrasound of the orbital region.
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CT scan may be done to delineate the extension of the infection.
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CT scan may be done to delineate the extension of the infection.
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Antibiotics are aimed at gram positive bacteria.
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Antibiotics are aimed at gram positive bacteria.
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Medical attention should be sought if symptoms persist beyond 2–3 days.
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Medical attention should be sought if symptoms persist beyond 2–3 days.
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There is inadequate evidence to draw conclusions about adjunctive corticosteroid therapy.
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There is inadequate evidence to draw conclusions about the adjunctive corticosteroid therapy in the treatment of periorbital cellulitis.
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Presence of proptosis, ophthalmoplegia, pain on eye movement, or loss of vision indicates orbital cellulitis, requiring IV antibiotics.
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If any of these features is present, one must assume that the patient has orbital cellulitis and begin treatment with IV antibiotics.
| Periorbital cellulitis | |
|---|---|
| Other names | Preseptal cellulitis |
| Periorbital cellulitis of the right eye caused by a dental infection (also causing maxillary sinusitis) | |
| Specialty | Ophthalmology |
Periorbital cellulitis, or preseptal cellulitis, is an inflammation and infection of the eyelid and portions of skin around the eye anterior to the orbital septum.[1] It may be caused by breaks in the skin around the eye, and subsequent spread to the eyelid; infection of the sinuses around the nose (sinusitis); or from spread of an infection elsewhere through the blood.
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Periorbital cellulitis must be differentiated from orbital cellulitis, which is an emergency and requires intravenous (IV) antibiotics. In contrast to orbital cellulitis, patients with periorbital cellulitis do not have bulging of the eye (proptosis), limited eye movement (ophthalmoplegia), pain on eye movement, or loss of vision. If any of these features is present, one must assume that the patient has orbital cellulitis and begin treatment with IV antibiotics. CT scan may be done to delineate the extension of the infection. [citation needed]
Affected individuals may experience: swelling, redness, discharge, pain, shut eye, conjunctival infection, fever (mild), slightly blurred vision, teary eyes, and some reduction in vision.[citation needed]
Typical signs include periorbital erythema, induration, tenderness and warmth.[2]
Staphylococcus aureus, Streptococcus pneumoniae, other streptococci, and anaerobes are the most common causes, depending on the origin of the infection.[3]
The advent of the Haemophilus influenzae vaccine has dramatically decreased the incidence.[4]
Tests include blood work (CBC) to rule out infectious cause. Also perform a CT scan, x ray of the anterior skull to view the sinuses, MRI scan and finally a soft tissue ultrasound of the orbital region.[citation needed]
Antibiotics are aimed at gram positive bacteria. Medical attention should be sought if symptoms persist beyond 2–3 days.[citation needed]
There is inadequate evidence to draw conclusions about the adjunctive corticosteroid therapy in the treatment of periorbital cellulitis. More research is needed to inform decision making.[5]
- ↑ "Orbital and periorbital cellulitis". HealthAtoZ.com. East Windsor, NJ: OptumHealth. Archived from the original on 26 June 2008.
- ↑ Givner LB (December 2002). "Periorbital versus orbital cellulitis". The Pediatric Infectious Disease Journal. 21 (12): 1157–1158. doi:10.1097/00006454-200212000-00014. PMID 12488668.
- ↑ Botting AM, McIntosh D, Mahadevan M (March 2008). "Paediatric pre- and post-septal peri-orbital infections are different diseases. A retrospective review of 262 cases". International Journal of Pediatric Otorhinolaryngology. 72 (3): 377–383. doi:10.1016/j.ijporl.2007.11.013. PMID 18191234.
- ↑ Donahue SP, Schwartz G (October 1998). "Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum". Ophthalmology. 105 (10): 1902–5, discussion 1905–6. doi:10.1016/S0161-6420(98)91038-7. PMID 9787362.
- ↑ Kornelsen E, Mahant S, Parkin P, Ren LY, Reginald YA, Shah SS, Gill PJ, et al. (Cochrane Eyes and Vision Group) (April 2021). "Corticosteroids for periorbital and orbital cellulitis". The Cochrane Database of Systematic Reviews. 2021 (4) CD013535. doi:10.1002/14651858.CD013535.pub2. PMC 8092453. PMID 33908631.