Periorbital cellulitis

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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.

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