Periorbital cellulitis: Difference between revisions
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==Characteristics== | ==Characteristics== | ||
[[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. | * [[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> | |||
==Causes== | ==Causes== | ||
Revision as of 12:29, 21 October 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.
Characteristics
- 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.[1]
- 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.[2]
- 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. [3]
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.
Treatment
Antimicrobial Regimens
- Periocular infection[4]
- 1. Causative pathogens
- Streptococcus spp.
- Methicillin-sensitive Staphylococcus aureus (MSSA)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Hemophilus influenzae
- 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 (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 (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 (4): Vancomycin 1 g IV q12h for 1-2 weeks
- 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
- 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
- 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 (3): Linezolid 600 mg IV or PO q12h for 1-2 weeks
See also
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.