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

Causes

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.[4]

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. Those with more severe disease or are less than one year of age, should be admitted to the hospital.

Antimicrobial Regimens

  • Periocular infection[5]
  • 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

See also

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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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