Periorbital (preseptal) cellulitis is an infection of the eyelid and skin around the eye that stays in front of the orbital septum. It is common in children and usually mild, but it must be told apart from orbital cellulitis, which threatens vision and life.
Key symptoms
- Red, swollen, tender eyelid, usually on one side
- Mild fever
- Recent sinusitis, insect bite, stye or skin scratch
- Eye itself feels normal and vision is clear
What you find on exam
- Eyelid swelling and redness, sometimes enough to close the eye
- Normal eye movements without pain
- No proptosis (bulging eye)
- Normal visual acuity and pupils
- Skin wound, bite or sinus tenderness
Tests
- Mostly a clinical diagnosis
- Blood count and CRP if the patient looks unwell
- CT of orbits and sinuses with contrast if pain with eye movement, proptosis, vision change or no improvement
- Culture of any drainage
Treatment basics
- Oral antibiotics such as amoxicillin-clavulanate
- Add MRSA coverage, such as clindamycin or trimethoprim-sulfamethoxazole, if risk
- Warm compresses
- Recheck in 24 to 48 hours
- IV antibiotics and admission for young infants, toxic appearance or failed oral therapy
Red flags
- Pain with eye movement or limited eye movement
- Bulging eye, double vision or reduced vision
- Headache, confusion or signs of meningitis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.