What is Periorbital Cellulitis?
Periorbital cellulitis is a skin and soft tissue infection around the eye, but anterior to the orbital septum. It is often called preseptal cellulitis. Periorbital cellulitis can occur at any age, but it is especially common in children. It is important to differentiate periorbital cellulitis from the less common, but more serious orbital cellulitis.
Key Takeaways
- Periorbital cellulitis is caused by Staph and Strep bacteria.
- It occurs most often in children due to sinusitis or trauma.
- Periorbital cellulitis must be differentiated from the serious orbital cellulitis.
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Periorbital Cellulitis vs Orbital Cellulitis
The most common bacterial causes of periorbital cellulitis are Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes. Complications from periorbital cellulitis are rare, but it must be differentiated from orbital cellulitis, a serious condition. Orbital cellulitis is an infection of the eyeball and the tissues around it.
Orbital cellulitis has the same signs and symptoms as periorbital cellulitis because it involves the periorbital tissue, but it also results in proptosis, pain with eye movement, swelling of the conjunctiva, ophthalmoplegia, or decreased vision.
If left untreated, periorbital cellulitis may lead to orbital cellulitis and loss of vision. In extreme cases, it may extend further and result in a subperiosteal abscess, orbital abscess, cavernous sinus thrombosis, and intracranial infection such as intracerebral abscess, meningitis, empyema or abscess of the epidural or subdural space.
What Causes Periorbital Cellulitis?
Periorbital cellulitis is most common in children due to sinusitis or trauma. Periorbital cellulitis is commonly caused by the spread of rhinosinusitis. Acute ethmoiditis is the most common rhinosinusitis causing periorbital and orbital cellulitis. An infection stemming from the ethmoid sinus progresses rapidly because the lamina is very thin between the ethmoid sinus and the periorbital and orbital areas. Sinusitis, hematogenous seeding, direct inoculation of the skin such as with insect bites, periocular or facial trauma, and impetigo are often causes of periorbital cellulitis.
Periorbital Cellulitis Symptoms
- Unilateral eyelid swelling
- Redness of the lid
- Fever
- Pain
Diagnosing Periorbital Cellulitis
A clinical examination by an eye doctor is needed to diagnose periorbital cellulitis from orbital cellulitis. Patients with orbital cellulitis present with eyelid swelling and other ocular symptoms such as proptosis, eye pain, decreased vision, and limited eye muscle motility.
Many patients have a history of sinusitis or upper respiratory infection, trauma, infection from a nearby area, or insect bites.
A computed tomography (CT) scan of the orbits and sinuses can aid in making the diagnosis. If unclear, patients are treated as if they have the diagnosis of orbital cellulitis.
Periorbital Cellulitis Treatment
Most cases of periorbital cellulitis resolve after five to seven days with proper antibiotic treatment. The treatment for periorbital cellulitis should include coverage for the most common bacteria, Staphylococcus aureus, and the Streptococcus species. The current recommendation is Clindamycin or TMP-SMX plus Amoxicillin-clavulanic acid or Cefpodoxime or Cefdinir.
Treatment also depends on severity and age. Those with more severe diseases or under the age of 1, should be admitted to the hospital.
