Periorbital cellulitis

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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.

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[1]
  • 1. Causative pathogens
  • Streptococcus spp.
  • Methicillin-sensitive Staphylococcus aureus (MSSA)
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Hemophilus influenzae
  • 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

See also

References

  1. 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.

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