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A-Z Glossary

Table of Contents

Periorbital Cellulitis

Courtney Dryer, OD
Written byCourtney Dryer, OD
Courtney Dryer, OD
Courtney Dryer, ODOptometristCharlotte, NC

Bio

Dr. Courtney Dryer earned her doctorate from Southern College of Optometry, Memphis, Tennessee in 2011. She opened her own practice Autarchic Spec Shop in 2013 in Charlotte, NC. She has had the privilege of writing for numerous optometric publications and serving in various industry capacities. In 2015, Vision Monday named her a rising star and one of the most influential women in optometry. Her optometric passions include practice management, specialty contact lenses, and dry eye management.

  • Last updated March 6, 2023

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.

Bibliography

  1. Bae C, Bourget D. Periorbital Cellulitis. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
  2. Baiu I, Melendez E. Periorbital and Orbital Cellulitis. JAMA. 2020 Jan 14;323(2):196. doi: 10.1001/jama.2019.18211. PMID: 31935029.
  3. Malinow I, Powell KR. Periorbital cellulitis. Pediatr Ann. 1993 Apr;22(4):241-6. doi: 10.3928/0090-4481-19930401-08. PMID: 8510991.
  4. Williams KJ, Allen RC. Pediatric orbital and periorbital infections. Curr Opin Ophthalmol. 2019 Sep;30(5):349-355. doi: 10.1097/ICU.0000000000000589. PMID: 31261188.

Related Terms

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Puncta

play an important role in tear drainage. Puncta can be occluded to treat dry eye disease and may improve symptoms

Intraocular

refers to within the eye

White Dot Syndrome

is a collection of eye disorders characterized by whitish-yellow lesions that affect the layers of the retina

Accommodation Disorder

also known as accommodative dysfunction, is any problem with the focusing power of the eye

Aberrations

are flaws or imperfections in the way that an optical system constructs images

Iris Nevus

is a clump of melanocytes on the iris

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