Eye
Preseptal Cellulitis
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Preseptal Cellulitis
, Periorbital Cellulitis
See Also
Orbital Cellulitis
Red Eye
Erysipelas
Pathophysiology
Preseptal Cellulitis is a
Eyelid
soft tissue infection
Thin fibrous, septal membrane extends from orbital rim to lid margin
Forms a periosteal extension or septum that prevents extension or lid disease to orbit
Preseptal Cellulitis infections form anterior to the fibrous septum
Contrast with
Orbital Cellulitis
which involves the deeper tissues (esp. ethmoid or
Maxillary Sinus
itis)
Epidemiology
Typical onset at age 18 months to 3 years
Causes
Local
Eyelid
disease
Hordeolum
Chalazion
Eyelid
Trauma
(e.g.
Insect Bite
) with secondary infection (e.g.
Impetigo
)
Dental abscess or infection with local spread
Sinusitis
with local extension
Uncommon in Preseptal Cellulitis
Sinusitis
is usually precursor to
Orbital Cellulitis
Organisms
Trauma
Staphylococcus aureus
Group A Streptococcus
Bacteremia (less common with modern
Immunization
s)
Streptococcus Pneumoniae
Haemophilus
Influenza
e
Symptoms
Acute
Swollen Red Eyelid
No fever
No orbital pain or
Extraocular Movement
pain
Contrast with painful
Extraocular Movement
s in
Orbital Cellulitis
Signs
Periorbital rash
Pink, violaceous swelling of lid margins
Multiple features differentiate Periorbital Cellulitis from the worrisome
Orbital Cellulitis
No
Extraocular Movement
pain or weakness (
Ophthalmoplegia
)
No
Proptosis
Normal
Vision
Normal pupil reflexes
No
Conjunctiva
l injection (
Conjunctivitis
)
No cells and flare (
Iritis
)
No limitation or pain on eye movement
No
Chemosis
No retrobulbar globe pressure
No
Papilledema
Differential Diagnosis
See
Eyelid Inflammation
Orbital Cellulitis
Inflames or entraps extraocular
Muscle
s with painful or reduced
Extraocular Movement
May be associated with
Diplopia
and disconjugate gaze
Management
Admit all cases of
Orbital Cellulitis
Typical Preseptal Cellulitis may be treated outpatient with oral antibiotics and close interval follow-up
Close observation to rule out
Orbital Cellulitis
Hospitalize and treat
Parenteral
ly with broad spectrum antibiotics if evidence of bacteremia or toxicity
See
Orbital Cellulitis
Lumbar Puncture
if suspect bacteremia source
Antibiotic Course: 10 days
Two antibiotic regimen is recommended
Sanford recommends second agent for added
MRSA
coverage
Antibiotic 1 (choose one): Primary Preseptal Cellulitis coverage
Amoxicillin
-Clavulanate (
Augmentin
)
Cefpodoxime
(
Vantin
)
Cefuroxime
(
Ceftin
)
Cefprozil
(
Cefzil
)
Cefdinir
(
Omnicef
)
Antibiotic 2 (choose one):
MRSA
Coverage
Trimethoprim Sulfamethoxazole
(
Septra
,
Bactrim
)
Doxycycline
Clindamycin
Complications
Orbital Cellulitis
(from contigious extension)
Uncommon (<10% of
Orbital Cellulitis
extends from Preseptal Cellulitis)
Most
Orbital Cellulitis
is an extension from ethmoid or
Maxillary Sinus
itis
Intracerebral extension of Preseptal Cellulitis is rare without
Orbital Cellulitis
extension
Protective fibrous layer prevents extension
References
(2023) Sanford Guide, accessed 7/1/2023
Williams (2017) Crit Dec Emerg Med 31(2): 3-12
Broder (2023) Crit Dec Emerg Med 37(11): 20-2
Givner (2002) Pediatr Infect Dis 21:1157-8 [PubMed]
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