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Periorbital Cellulitis

Periorbital Cellulitis

What is it??

ÿInside of our eye sockets there s a thin wall called the orbital septum that separates the area in the front of our eyes, in the front of that wall, from the areas in the back:

Periorbital Cellulitis is an infection of the eyelid and surrounding tissues in front of the septum Periorbital cellulitis is often called Preseptal cellulitis, the two terms are used interchangeably

Orbital Cellulitis is an infection of the orbital tissues behind the orbital septum

ÿWhich infection might develop is determined by which side of that wall it s on:
Preseptal Cellulitis is caused by things in front of the wall from outside of the eye socket:

Spread from local facial infections or eyelid injuries Insect or animal bites
Conjunctivitis
Chalazion

Sinusitis
Orbital Cellulitis is caused by things behind the wall from inside of the eye socket:

direct infection from nearby sinuses
accompanying local trauma (eg, insect or animal bite, penetrating eyelid injuries) Spread of infection from the face or teeth

ÿThese two processes have much in common:

Eyelid pain, discoloration, & swelling Fever & Malaise
Both are more common among children

Preseptal cellulitis is far more common than orbital cellulitis.

ÿComplications include:

Vision loss (3 to 11%) due to ischemic retinopathy and optic neuropathy caused by increased intraorbital pressure;
Restricted ocular movements (ophthalmoplegia)

ÿSymptoms and Signs

Preseptal Cellulitis

Tenderness, swelling, warmth, redness or discoloration of the eyelid(s) Visual acuity is not affected
Ocular movement is intact
The globe is NOT pushed forward (proptosis)

Orbital Cellulitis

Swelling and redness of the eyelid and surrounding soft tissues Conjunctival hyperemia and chemosis
Decreased ocular motility
Pain with eye movements

Decreased visual acuity
Proptosis caused by orbital swelling

Fever is usually present
Headache and lethargy should raise suspicion of associated meningitis. Some or all of these findings may be absent early in the course of the infection.

ÿ Diagnosis

These are both mainly clinical diagnosis
If Orbital Cellulitis is suspected consider a CT or MRI

Suspect orbital cellulitis and consult an ophthalmologist if there is decreased ocular motility, pain with eye movements, proptosis, or decreased visual acuity.

ÿTake Home Points!!

Periorbital (Preseptal) Cellulitis occur in front of the orbital septum

Orbital Cellulitis occurs behind

Periorbital Cellulitis is usually caused by spread from local facial or eyelid injuries, insect or animal bites, conjunctivitis, and chalazion

Orbital is usually caused by contiguous spread of ethmoid or frontal sinusitis, penetrating trauma, and by the blood

Both can cause tenderness, swelling, warmth, redness or discoloration of the eyelid, and fever.
Orbital cellulitis is more likely if there is decreased ocular motility, pain with eye movements, bulging of the eye, or decreased visual acuity.
Antibiotic therapy is always indicated

Surgery reserved for Orbital Cellulitis complicated by abscess formation, foreign body, impaired vision, or antibiotic failure.