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{{SK}} Preseptal cellulitis
{{SK}} Preseptal cellulitis


==Overview==
==Overview==
'''Periorbital cellulitis''', also known as preseptal cellulitis, is an inflammation and infection of the eyelid and portions of skin around the eye. 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.  
[[Periorbital cellulitis]] is an [[inflammation]] and [[infection]] of the eyelid and area around the eye. [[Periorbital cellulitis]] is also called [[preseptal cellulitis]] because it affects the structures in front of the [[septum]], such as the eyelid and skin around the eye. [[Periorbital cellulitis]] often occurs from a scratch or insect bite around the eye that leads to infection of the skin. Symptoms can include swelling, redness, pain, and tenderness to touch occurring around one eye only. The affected person is able to move the eye in all directions without pain, but there can be difficulty opening the eyelid, often due to swelling. Also vision is normal.


==Characteristics==
==Historical Perspective==
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, and 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. [[computed tomography|CT]] scan may be done to delineate the extension of the infection.
* Donahue and Schwartz have described 70 cases of [[periorbital cellulitis]] from 1986 to 1996 at their institution.<ref name="pmid9787362">{{cite journal| author=Donahue SP, Schwartz G| title=Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum. | journal=Ophthalmology | year= 1998 | volume= 105 | issue= 10 | pages= 1902-5; discussion 1905-6 | pmid=9787362 | doi=10.1016/S0161-6420(98)91038-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9787362  }} </ref>
 
==Classification==
* [[Periorbital cellulitis]] must be differentiated from [[orbital cellulitis]], which is an [[infection]] involving the [[soft tissues]] posterior to the [[orbital septum]], including the fat and muscle within the bony orbit ant it is an emergency and sight-threatening situation. 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, and 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.<ref name="pmid7955474">{{cite journal| author=Cox NH, Knowles MA, Porteus ID| title=Pre-septal cellulitis and facial erysipelas due to Moraxella species. | journal=Clin Exp Dermatol | year= 1994 | volume= 19 | issue= 4 | pages= 321-3 | pmid=7955474 | doi=10.1111/j.1365-2230.1994.tb01204.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7955474  }} </ref>
 
* Both [[periorbital cellulitis]] and [[orbital cellulitis]] occur more commonly in children and can present with eyelid [[inflammation]], and distinguishing between the two conditions may be challenging. Hence, the evaluation should include a comprehensive ophthalmic examination, including an assessment of visual acuity, [[pupillary]] response, [[tonometry]], [[anterior]] segment [[biomicroscopy]], and [[ophthalmoscopy]]. A physical examination, including an assessment of routine vital signs, should be performed. Blood cultures should be obtained in patients with concern for systemic [[toxicity]].<ref name="pmid15533168">{{cite journal| author=Howe L, Jones NS| title=Guidelines for the management of periorbital cellulitis/abscess. | journal=Clin Otolaryngol Allied Sci | year= 2004 | volume= 29 | issue= 6 | pages= 725-8 | pmid=15533168 | doi=10.1111/j.1365-2273.2004.00889.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15533168  }} </ref>
 
* A common cause of [[preseptal cellulitis]] is extension of infection from the [[paranasal sinuses]], [[sinusitis]]. Other causes include trauma, foreign bodies, insect bites, skin infections ([[impetigo]]), eyelid lesions ([[chalazia]], [[hordeola]]), and [[iatrogenic]] causes such as eyelid and oral procedures. <ref name="pmid23960899">{{cite journal| author=Lee S, Yen MT| title=Management of preseptal and orbital cellulitis. | journal=Saudi J Ophthalmol | year= 2011 | volume= 25 | issue= 1 | pages= 21-9 | pmid=23960899 | doi=10.1016/j.sjopt.2010.10.004 | pmc=3729811 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23960899  }} </ref>
 
==Pathophysiology==
* The most common inciting events of [[periorbital cellulitis]] include [[sinusitis]] specially [[ethmoiditis]], [[hematogenous]] seeding, insect bites, [[periocular]] or facial trauma, and [[impetigo]]. [[Pathogens]] spread to nearby tissues through the [[ophthalmic]] venous system or the [[lamina papyracea]].<ref name="pmid29719647">{{cite journal| author=Hamed-Azzam S, AlHashash I, Briscoe D, Rose GE, Verity DH| title=Common Orbital Infections ~ State of the Art ~ Part I. | journal=J Ophthalmic Vis Res | year= 2018 | volume= 13 | issue= 2 | pages= 175-182 | pmid=29719647 | doi=10.4103/jovr.jovr_199_17 | pmc=5905312 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29719647  }} </ref>
* In a retrospective review of 104 patients with [[periorbital cellulitis]] over a 15-year period, the most common predisposing etiologies were acute [[dacryocystitis]] (32.6%), [[sinusitis]] and upper [[respiratory]] infection (28.8%), and recent trauma or surgery (27.8%).<ref name="pmid23960899">{{cite journal| author=Lee S, Yen MT| title=Management of preseptal and orbital cellulitis. | journal=Saudi J Ophthalmol | year= 2011 | volume= 25 | issue= 1 | pages= 21-9 | pmid=23960899 | doi=10.1016/j.sjopt.2010.10.004 | pmc=3729811 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23960899  }} </ref>


==Causes==
==Causes==
''[[Staphylococcus]]'' and ''[[streptococcus]]'' species are commonly implicated. The advent of the [[Haemophilus influenzae]] vaccine has dramatically decreased the incidence of periorbital and orbital cellulitis.
* The most common bacterial germs causing [[periorbital cellulitis]] are [[Staphylococcus aureus]], [[Streptococcus pneumoniae]], and [[Streptococcus pyogenes]]. With increased vaccination, there are fewer cases of [[Haemophilus influenzae]] as a causative organism. Less common causes are [[Acinetobacter]], [[Nocardia]], [[Pseudomonas]], [[Neisseria]], [[Mycobacterium]] and [[fungal]] infections.<ref name="pmid27192038">{{cite journal| author=Gonçalves R, Menezes C, Machado R, Ribeiro I, Lemos JA| title=Periorbital cellulitis in children: Analysis of outcome of intravenous antibiotic therapy. | journal=Orbit | year= 2016 | volume= 35 | issue= 4 | pages= 175-80 | pmid=27192038 | doi=10.1080/01676830.2016.1176205 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27192038  }} </ref>
 
==Differentiating periorbital cellulitis from other Diseases==
* It is important to differentiate [[periorbital cellulitis]] from [[orbital cellulitis]], [[allergic]] reactions, orbital tumors, [[exophthalmos]], [[chalazion]] and [[hordeolum]].
* In neonatal patients [[gonorrhoea]] and [[Chlamydia]] infection should be considered.<ref name="pmid23960899">{{cite journal| author=Lee S, Yen MT| title=Management of preseptal and orbital cellulitis. | journal=Saudi J Ophthalmol | year= 2011 | volume= 25 | issue= 1 | pages= 21-9 | pmid=23960899 | doi=10.1016/j.sjopt.2010.10.004 | pmc=3729811 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23960899  }} </ref>
 
==Epidemiology and Demographics==
* [[Periorbital cellulitis]] can occur at any age, but it is common in children and it is more common than [[orbital cellulitis]] in this population.<ref name="pmid23960899">{{cite journal| author=Lee S, Yen MT| title=Management of preseptal and orbital cellulitis. | journal=Saudi J Ophthalmol | year= 2011 | volume= 25 | issue= 1 | pages= 21-9 | pmid=23960899 | doi=10.1016/j.sjopt.2010.10.004 | pmc=3729811 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23960899  }} </ref>
 
==Risk Factors==
* The risk factors include trauma, insect bite, localized or systemic [[infection]] and postsurgical.<ref name="pmid19149979">{{cite journal| author=Babar TF, Zaman M, Khan MN, Khan MD| title=Risk factors of preseptal and orbital cellulitis. | journal=J Coll Physicians Surg Pak | year= 2009 | volume= 19 | issue= 1 | pages= 39-42 | pmid=19149979 | doi=01.2009/JCPSP.3942 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19149979  }} </ref>
 
==Screening==
* There is insufficient evidence to recommend routine screening for [[periorbital cellulitis]].
 
==Natural History, Complications, and Prognosis==
* With inadequate treatment, [[periorbital cellulitis]] can lead to complications such as [[orbital cellulitis]] and loss of vision, [[subperiosteal]] [[abscess]], [[orbital]] abscess, or [[cavernous sinus thrombosis]]and [[intracranial]] infection such as [[intracerebral]] abscess, [[meningitis]], [[empyema]] or abscess of the [[epidural]] or [[subdural]] space in severe cases.<ref name="pmid23960899">{{cite journal| author=Lee S, Yen MT| title=Management of preseptal and orbital cellulitis. | journal=Saudi J Ophthalmol | year= 2011 | volume= 25 | issue= 1 | pages= 21-9 | pmid=23960899 | doi=10.1016/j.sjopt.2010.10.004 | pmc=3729811 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23960899  }} </ref>
 
==Diagnosis==
===Diagnostic Study of Choice===
* The diagnosis of [[periorbital cellulitis]] is mainly a clinical diagnosis with radiologic findings.
 
===History and Symptoms===
* Clinical assessment should evaluate a patient’s general appearance and local conditions to differentiate [[periorbital cellulitis]] with [[orbital cellulitis]]. A meticulous examination based on the recognition of distinctive signs, relevant history and an evaluation of predisposing risk factors is essential in diagnosis and expeditious treatment.
* Assessment of visual acuity, pupillary response, examination of the ocular [[adnexa]] and globe are paramount.
* [[Periorbital cellulitis]] typically presents with eyelid [[oedema]] and [[erythema]], features characteristic of [[cellulitis]]. The extent of [[infection]] is superficial and does not extend posteriorly into the [[orbit]]. Hence, patients with [[periorbital cellulitis]] will present with normal vision, absence of [[proptosis]], and full ocular motility without pain on movement.<ref name="pmid30654566">{{cite journal| author=Torretta S, Guastella C, Marchisio P, Marom T, Bosis S, Ibba T | display-authors=etal| title=Sinonasal-Related Orbital Infections in Children: A Clinical and Therapeutic Overview. | journal=J Clin Med | year= 2019 | volume= 8 | issue= 1 | pages=  | pmid=30654566 | doi=10.3390/jcm8010101 | pmc=6351922 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30654566  }} </ref><ref name="pmid23960899">{{cite journal| author=Lee S, Yen MT| title=Management of preseptal and orbital cellulitis. | journal=Saudi J Ophthalmol | year= 2011 | volume= 25 | issue= 1 | pages= 21-9 | pmid=23960899 | doi=10.1016/j.sjopt.2010.10.004 | pmc=3729811 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23960899  }} </ref>
 
===Physical Examination===
* Physical examination, including an assessment of routine vital signs, visual acuity and eye movement. Local examination generally reveals associated symptoms like eyelid and [[periorbital]] swelling, tenderness, [[erythema]], warmth, [[proptosis]], [[ophthalmoplegia]], and impaired vision.<ref name="pmid23960899">{{cite journal| author=Lee S, Yen MT| title=Management of preseptal and orbital cellulitis. | journal=Saudi J Ophthalmol | year= 2011 | volume= 25 | issue= 1 | pages= 21-9 | pmid=23960899 | doi=10.1016/j.sjopt.2010.10.004 | pmc=3729811 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23960899  }} </ref>
 
===Laboratory Findings===
* [[Blood cultures]] are not performed routinely. They are difficult to obtain in those with [[periorbital cellulitis]] and are usually negative. However, laboratory tests, including assessment of [[white blood cell]] counts and serum [[C-reactive protein]] levels may be useful in children with [[fever]].<ref name="pmid2795411">{{cite journal| author=Molarte AB, Isenberg SJ| title=Periorbital cellulitis in infancy. | journal=J Pediatr Ophthalmol Strabismus | year= 1989 | volume= 26 | issue= 5 | pages= 232-4; discussion 235 | pmid=2795411 | doi=10.1097/00006454-199008000-00030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2795411  }} </ref>
 
===X-ray===
* There are no x-ray findings associated with [[periorbital cellulitis]].
 
===CT scan===
*  A [[CT scan]] of the [[orbits]] and [[sinuses]] allows differentiation of the [[periorbital cellulitis]] and [[orbital cellulitis]] , as well as a way to determine the extent of the [[infection]]. The [[CT scan]] of [[periorbital cellulitis]] shows eyelid [[swelling]], no [[proptosis]], no [[fat stranding]] of [[orbital]] contents, and no involvement of the [[extraocular]] muscles.<ref name="pmid26366442">{{cite journal| author=Grischkan JM, Elmaraghy CA, Garrett MR, Karanfilov B, Jatana KR| title=Radiographic Findings and Clinical Correlates in Pediatric Periorbital Infections. | journal=Int J Otorhinolaryngol | year= 2015 | volume= 2 | issue= 1 | pages=  | pmid=26366442 | doi=10.13188/2380-0569.1000004 | pmc=4563871 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26366442  }} </ref>
*  In cases where [[abscesses]] are suspected, a [[brain CT]] is required to rule out [[intracranial]] involvement. A [[CT scan]] is also recommended if marked eyelid [[swelling]], fever, [[leukocytosis]], or no improvement after 24 hours of the proper [[antibiotics]].
 
===MRI===
* [[MRI]] does not have indication in [[periorbital cellulitis]]
 
===Other Imaging Findings===
* There are no other imaging findings associated with [[periorbital cellulitis]].
 
===Other Diagnostic Studies===
* There are no other diagnostic studies associated with [periorbital cellulitis]].


==Treatment==
==Treatment==
*Periocular infection<ref name="pmid17700236">{{cite journal| author=Bilyk JR| title=Periocular infection. | journal=Curr Opin Ophthalmol | year= 2007 | volume= 18 | issue= 5 | pages= 414-23 | pmid=17700236 | doi=10.1097/ICU.0b013e3282dd979f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17700236  }} </ref>
* The treatment of [[periorbital cellulitis]] differs based on the severity of disease and age of the patient. The mainstay of treatment is usually antibiotic coverage against [[staphylococcus aureus]], the [[streptococcus]] species, and [[anaerobes]]. Patients who are over one year of age with mild symptoms can be treated as an outpatient with oral [[antibiotics]]. However, if the patient does not respond to oral [[antibiotics]] in 48 hours or if extension of the infectious process into the [[orbit]] is suspected, he or she should be admitted to the hospital and a [[CT scan]] must be performed to evaluate for orbital extension, and [[intravenous]] [[antibiotics]] must be indicated. Those with more severe disease or are less than one year of age, should be admitted to the hospital.
 
* Usually children under 2 years of age or febrile patients with a severe [[cellulitis]] are managed with intravenous [[antibiotics]] during hospitalization, with close followup. Hospitalization is also recommended in patients who cannot be followed up as outpatients. Intravenous [[antibiotics]] are usually indicated for two or three days, depending on improvement. If the condition improves, treatment can be switched to the appropriate oral [[antibiotics]] based on cultures.
 
===Medical Therapy===
*'''Periocular infection'''<ref name="pmid17700236">{{cite journal| author=Bilyk JR| title=Periocular infection. | journal=Curr Opin Ophthalmol | year= 2007 | volume= 18 | issue= 5 | pages= 414-23 | pmid=17700236 | doi=10.1097/ICU.0b013e3282dd979f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17700236  }} </ref>
:*'''1. Causative pathogens'''
:*'''1. Causative pathogens'''
::*Streptococcus spp.
::*[[Streptococcus]] spp.
::*Methicillin-sensitive Staphylococcus aureus (MSSA)
::*Methicillin-sensitive [[Staphylococcus aureus]] (MSSA)
::*Methicillin-resistant Staphylococcus aureus (MRSA)
::*Methicillin-resistant [[Staphylococcus aureus]] (MRSA)
::*Hemophilus influenzae
::*Hemophilus influenzae
:*'''2. Empiric antimicrobial therapy'''
:*'''2. Empiric antimicrobial therapy'''
::*Preferred regimen (1): [[Clindamycin]] 300-450 mg PO q6h for 1-2 weeks {{or}} [[Clindamycin]] 600-900 mg IV q8h for 1-2 weeks
::*Preferred regimen (1): [[Clindamycin]] 300-450 mg PO q6h for 1-2 weeks or [[Clindamycin]] 600-900 mg IV q8h for 1-2 weeks
::*Preferred regimen (2): [[Daptomycin]] 4 mg/kg IV qd for 1-2 weeks
::*Preferred regimen (2): [[Daptomycin]] 4 mg/kg IV qd for 1-2 weeks
::*Alternative regimen (1): [[Trimethoprim]]/[[Sulfamethoxazole]] 160 mg PO q12h for 1-2 weeks {{or}} [[Trimethoprim]]/[[Sulfamethoxazole]] 2.5 mgkg IV q12h for 1-2 weeks
::*Alternative regimen (1): [[Trimethoprim]]/[[Sulfamethoxazole]] 160 mg PO q12h for 1-2 weeks or  [[Trimethoprim]]/[[Sulfamethoxazole]] 2.5 mgkg IV q12h for 1-2 weeks
::*Alternative regimen (2): [[Doxycycline]] 100 mg IV or PO q12h for 1-2 weeks
::*Alternative regimen (2): [[Doxycycline]] 100 mg IV or PO q12h for 1-2 weeks
::*Alternative regimen (3): [[Linezolid]] 600 mg IV or PO q12h for 1-2 weeks
::*Alternative regimen (3): [[Linezolid]] 600 mg IV or PO q12h for 1-2 weeks
Line 36: Line 99:
:::*Alternative regimen (1): [[Trimethoprim]]/[[Sulfamethoxazole]] 160 mg PO q12h for 1-2 weeks {{or}}  [[Trimethoprim]]/[[Sulfamethoxazole]] 2.5 mgkg IV q12h for 1-2 weeks
:::*Alternative regimen (1): [[Trimethoprim]]/[[Sulfamethoxazole]] 160 mg PO q12h for 1-2 weeks {{or}}  [[Trimethoprim]]/[[Sulfamethoxazole]] 2.5 mgkg IV q12h for 1-2 weeks
:::*Alternative regimen (2): [[Doxycycline]] 100 mg IV or PO q12h for 1-2 weeks
:::*Alternative regimen (2): [[Doxycycline]] 100 mg IV or PO q12h for 1-2 weeks
:::*Alternative regimen (3): [[LinezolidTreatment==
:::*Alternative regimen (3): [[Linezolid]] 600 mg IV or PO q12h for 1-2 weeks
 
===Surgery===
* If medical therapy fails to show improvement after 24 to 48 hours, patients should be hospitalized and a surgical consultation should be considered for possible [[incision]] and [[drainage]]. Surgical [[drainage]] and [[debridement]] of a lid abscess can be performed by a small [[incision]] through the skin over an area of [[fluctuance]].<ref name="pmid23960899">{{cite journal| author=Lee S, Yen MT| title=Management of preseptal and orbital cellulitis. | journal=Saudi J Ophthalmol | year= 2011 | volume= 25 | issue= 1 | pages= 21-9 | pmid=23960899 | doi=10.1016/j.sjopt.2010.10.004 | pmc=3729811 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23960899  }} </ref>
* In patients with [[subperiosteal]] abscess, [[orbital]] abscess and [[cavernous sinus thrombosis]] surgery is necessary for drainage. Loculations within the cavity of the [[abscess]] must be broken, and packing of the wound should be considered to promote further [[drainage]].
 
===Primary Prevention===
* There are no established measures for the primary prevention of [[periorbital cellulitis]].
 
===Secondary Prevention===
* There are no established measures for the secondary prevention of [[periorbital cellulitis]].


==See also==
==See also==
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==References==
==References==
* {{cite journal |author=Donahue S, Schwartz G |title=Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum |journal=Ophthalmology |volume=105 |issue=10 |pages=1902-5; discussion 1905-6 |year=1998 |pmid=9787362}}
{{reflist}}
{{cite journal |author=Donahue S, Schwartz G |title=Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum |journal=Ophthalmology |volume=105 |issue=10 |pages=1902-5; discussion 1905-6 |year=1998 |pmid=9787362}}


==External links==
==External links==
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[[Category:Disease stubs]]
[[Category:Disease stubs]]


[[Category:Infectious Disease Project]]




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Latest revision as of 13:54, 28 October 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyed Arash Javadmoosavi, MD[2]

Synonyms and keywords: Preseptal cellulitis

Overview

Periorbital cellulitis is an inflammation and infection of the eyelid and area around the eye. Periorbital cellulitis is also called preseptal cellulitis because it affects the structures in front of the septum, such as the eyelid and skin around the eye. Periorbital cellulitis often occurs from a scratch or insect bite around the eye that leads to infection of the skin. Symptoms can include swelling, redness, pain, and tenderness to touch occurring around one eye only. The affected person is able to move the eye in all directions without pain, but there can be difficulty opening the eyelid, often due to swelling. Also vision is normal.

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating periorbital cellulitis from other Diseases

Epidemiology and Demographics

Risk Factors

  • The risk factors include trauma, insect bite, localized or systemic infection and postsurgical.[7]

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

  • Clinical assessment should evaluate a patient’s general appearance and local conditions to differentiate periorbital cellulitis with orbital cellulitis. A meticulous examination based on the recognition of distinctive signs, relevant history and an evaluation of predisposing risk factors is essential in diagnosis and expeditious treatment.
  • Assessment of visual acuity, pupillary response, examination of the ocular adnexa and globe are paramount.
  • Periorbital cellulitis typically presents with eyelid oedema and erythema, features characteristic of cellulitis. The extent of infection is superficial and does not extend posteriorly into the orbit. Hence, patients with periorbital cellulitis will present with normal vision, absence of proptosis, and full ocular motility without pain on movement.[8][4]

Physical Examination

  • Physical examination, including an assessment of routine vital signs, visual acuity and eye movement. Local examination generally reveals associated symptoms like eyelid and periorbital swelling, tenderness, erythema, warmth, proptosis, ophthalmoplegia, and impaired vision.[4]

Laboratory Findings

X-ray

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

  • There are no other diagnostic studies associated with [periorbital cellulitis]].

Treatment

  • The treatment of periorbital cellulitis differs based on the severity of disease and age of the patient. The mainstay of treatment is usually antibiotic coverage against staphylococcus aureus, the streptococcus species, and anaerobes. Patients who are over one year of age with mild symptoms can be treated as an outpatient with oral antibiotics. However, if the patient does not respond to oral antibiotics in 48 hours or if extension of the infectious process into the orbit is suspected, he or she should be admitted to the hospital and a CT scan must be performed to evaluate for orbital extension, and intravenous antibiotics must be indicated. Those with more severe disease or are less than one year of age, should be admitted to the hospital.
  • Usually children under 2 years of age or febrile patients with a severe cellulitis are managed with intravenous antibiotics during hospitalization, with close followup. Hospitalization is also recommended in patients who cannot be followed up as outpatients. Intravenous antibiotics are usually indicated for two or three days, depending on improvement. If the condition improves, treatment can be switched to the appropriate oral antibiotics based on cultures.

Medical Therapy

  • Periocular infection[11]
  • 1. Causative pathogens
  • 2. Empiric antimicrobial therapy
  • 3. Pathogen-directed antimicrobial therapy
  • 3.1 Methicillin-resistant Staphylococcus aureus
  • Preferred regimen (1): Vancomycin 1 g IV q12h for 1-2 weeks
  • 3.2 Non-MRSA organisms

Surgery

Primary Prevention

Secondary Prevention

See also

References

  1. Donahue SP, Schwartz G (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.
  2. Cox NH, Knowles MA, Porteus ID (1994). "Pre-septal cellulitis and facial erysipelas due to Moraxella species". Clin Exp Dermatol. 19 (4): 321–3. doi:10.1111/j.1365-2230.1994.tb01204.x. PMID 7955474.
  3. Howe L, Jones NS (2004). "Guidelines for the management of periorbital cellulitis/abscess". Clin Otolaryngol Allied Sci. 29 (6): 725–8. doi:10.1111/j.1365-2273.2004.00889.x. PMID 15533168.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Lee S, Yen MT (2011). "Management of preseptal and orbital cellulitis". Saudi J Ophthalmol. 25 (1): 21–9. doi:10.1016/j.sjopt.2010.10.004. PMC 3729811. PMID 23960899.
  5. Hamed-Azzam S, AlHashash I, Briscoe D, Rose GE, Verity DH (2018). "Common Orbital Infections ~ State of the Art ~ Part I." J Ophthalmic Vis Res. 13 (2): 175–182. doi:10.4103/jovr.jovr_199_17. PMC 5905312. PMID 29719647.
  6. Gonçalves R, Menezes C, Machado R, Ribeiro I, Lemos JA (2016). "Periorbital cellulitis in children: Analysis of outcome of intravenous antibiotic therapy". Orbit. 35 (4): 175–80. doi:10.1080/01676830.2016.1176205. PMID 27192038.
  7. Babar TF, Zaman M, Khan MN, Khan MD (2009). "Risk factors of preseptal and orbital cellulitis". J Coll Physicians Surg Pak. 19 (1): 39–42. doi:01.2009/JCPSP.3942 Check |doi= value (help). PMID 19149979.
  8. Torretta S, Guastella C, Marchisio P, Marom T, Bosis S, Ibba T; et al. (2019). "Sinonasal-Related Orbital Infections in Children: A Clinical and Therapeutic Overview". J Clin Med. 8 (1). doi:10.3390/jcm8010101. PMC 6351922. PMID 30654566.
  9. Molarte AB, Isenberg SJ (1989). "Periorbital cellulitis in infancy". J Pediatr Ophthalmol Strabismus. 26 (5): 232–4, discussion 235. doi:10.1097/00006454-199008000-00030. PMID 2795411.
  10. Grischkan JM, Elmaraghy CA, Garrett MR, Karanfilov B, Jatana KR (2015). "Radiographic Findings and Clinical Correlates in Pediatric Periorbital Infections". Int J Otorhinolaryngol. 2 (1). doi:10.13188/2380-0569.1000004. PMC 4563871. PMID 26366442.
  11. Bilyk JR (2007). "Periocular infection". Curr Opin Ophthalmol. 18 (5): 414–23. doi:10.1097/ICU.0b013e3282dd979f. PMID 17700236.

Donahue S, Schwartz G (1998). "Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum". Ophthalmology. 105 (10): 1902–5, discussion 1905-6. PMID 9787362.

External links


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