Eye

Preseptal Cellulitis

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Preseptal Cellulitis, Periorbital Cellulitis

  • Pathophysiology
  1. Fibrous membrane extends from orbital rim to lid margin
    1. Forms a periosteal extension or septum that prevents extension or lid disease to orbit
  2. Preseptal Cellulitis infections form anterior to the fibrous septum
    1. Contrast with Orbital Cellulitis which involves the deeper tissues
  • Epidemiology
  1. Typical onset at age 18 months to 3 years
  • Causes
  1. Local Eyelid disease
    1. Hordeolum
    2. Chalazion
  2. Eyelid Trauma (e.g. Insect Bite) with secondary infection (e.g. Impetigo)
  3. Dental abscess or infection with local spread
  4. Sinusitis with local extension
    1. Uncommon in Preseptal Cellulitis
    2. Sinusitis is usually precursor to Orbital Cellulitis
  • Symptoms
  1. Acute Swollen Red Eyelid
  2. No fever
  3. No orbital pain
    1. Contrast with painful estraocular movements in Orbital Cellulitis
  • Signs
  1. Periorbital rash
    1. Pink, violaceous swelling of lid margins
  2. No Proptosis
  3. Normal vision
  4. Normal pupil reflexes
  5. No Conjunctival injection (Conjunctivitis)
  6. No cells and flare (Iritis)
  7. No limitation or pain on eye movement
  8. No Chemosis
  9. No retrobulbar globe pressure
  10. No Papilledema
  • Differential Diagnosis
  • Management
  1. Close observation to rule out Orbital Cellulitis
    1. Hospitalize and treat parenterally with broad spectrum antibiotics if evidence of bacteremia or toxicity
    2. See Orbital Cellulitis
    3. Lumbar Puncture if suspect bacteremia source
  2. Antibiotic Course: 10 days
  3. Typical antibiotic coverage
    1. Amoxicillin-Clavulanate (Augmentin)
    2. Cefuroxime (Ceftin) or
    3. Cefpodoxime
    4. Cefprozil (Cefzil)
  4. Trauma Source (alone or in combination with above agents)
    1. Consider MRSA coverage (Septra, Doxycyline)
    2. Cephalexin
    3. Clindamycin
    4. Dicloxacillin
  • Complications
  1. Orbital Cellulitis (from contigious extension)
  2. Intracerebral extension of Preseptal Cellulitis is rare without Orbital Cellulitis extension
    1. Protective fibrous layer prevents extension
  • References
  1. Williams (2017) Crit Dec Emerg Med 31(2): 3-12
  2. Givner (2002) Pediatr Infect Dis 21:1157-8 [PubMed]