Eye
Preseptal Cellulitis
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Preseptal Cellulitis
, Periorbital Cellulitis
See Also
Orbital Cellulitis
Red Eye
Erysipelas
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
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
Contrast with painful estraocular movements in
Orbital Cellulitis
Signs
Periorbital rash
Pink, violaceous swelling of lid margins
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
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
Complications
Orbital Cellulitis
(from contigious extension)
Intracerebral extension of Preseptal Cellulitis is rare without
Orbital Cellulitis
extension
Protective fibrous layer prevents extension
References
Williams (2017) Crit Dec Emerg Med 31(2): 3-12
Givner (2002) Pediatr Infect Dis 21:1157-8 [PubMed]
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