II. Pathophysiology
- Fibrous 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
III. Epidemiology
- Typical onset at age 18 months to 3 years
IV. Causes
- Local Eyelid disease
- 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
V. Organisms
- Trauma
- Bacteremia (less common with modern Immunizations)
VI. Symptoms
- Acute Swollen Red Eyelid
- No fever
- No orbital pain
- Contrast with painful estraocular movements in Orbital Cellulitis
VII. Signs
- Periorbital rash
- Pink, violaceous swelling of lid margins
- No Proptosis
- Normal vision
- Normal pupil reflexes
- No Conjunctival injection (Conjunctivitis)
- No cells and flare (Iritis)
- No limitation or pain on eye movement
- No Chemosis
- No retrobulbar globe pressure
- No Papilledema
VIII. Differential Diagnosis
IX. Management
- Close observation to rule out Orbital Cellulitis
- Hospitalize and treat parenterally with broad spectrum antibiotics if evidence of bacteremia or toxicity
- See Orbital Cellulitis
- Lumbar Puncture if suspect bacteremia source
- Antibiotic Course: 10 days
- Typical antibiotic coverage
- Amoxicillin-Clavulanate (Augmentin)
- Cefuroxime (Ceftin) or
- Cefpodoxime
- Cefprozil (Cefzil)
-
Trauma Source (alone or in combination with above agents)
- Consider MRSA coverage (Septra, Doxycyline)
- Cephalexin
- Clindamycin
- Dicloxacillin
X. Complications
- Orbital Cellulitis (from contigious extension)
- Intracerebral extension of Preseptal Cellulitis is rare without Orbital Cellulitis extension
- Protective fibrous layer prevents extension
XI. References
- Williams (2017) Crit Dec Emerg Med 31(2): 3-12
- Givner (2002) Pediatr Infect Dis 21:1157-8 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Disease or Syndrome (T047) |
SnomedCT | 314516007 |
English | preseptal cellulitis, cellulitis preseptal, Preseptal cellulitis (disorder), Preseptal cellulitis |
Czech | Preseptální celulitida |
Dutch | preseptale bloeding |
French | Cellulite préseptale |
German | Praeseptale Zellulitis |
Hungarian | Preseptalis cellulitis |
Italian | Cellulite presettale |
Spanish | Celulitis preseptal, celulitis preseptal (trastorno), celulitis preseptal |
Japanese | 眼窩隔膜前蜂巣炎, ガンカカクマクゼンホウソウエン |
Portuguese | Celulite pré-septal |