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Preseptal CellulitisAka: Periorbital Cellulitis

Pathophysiology
1. Fibrous membrane extends from orbit rim to lid margin
  1. Septum prevents extension or lid disease to orbit
Epidemiology
1. Typical onset at age 18 months to 3 years
Causes
1. Local lid disease
  1. Hordeolum
  2. Chalazion
2. Lid trauma (e.g. Insect Bite) with secondary infection
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
Organisms
1. Trauma
  1. Staphylococcus aureus
  2. Group A Streptococcus
2. Bacteremia
  1. Streptococcus Pneumoniae
Signs
1. Periorbital rash
  1. Pink, violaceous swelling of lid margins
2. No Proptosis
3. No limitation or pain on eye movement
4. No Chemosis
5. No retrobulbar globe pressure
6. No Papilledema
Complications
1. Intracerebral extension of preseptal Cellulitis rare
  1. Protective fibrous layer prevents extension
Differential Diagnosis
1. See Eyelid Inflammation
2. Orbital Cellulitis
Management
1. Close observation to rule out Orbital Cellulitis
  1. Hospitalize for evidence of bacteremia
  2. Lumbar Puncture if suspect bacteremia source
2. Antibiotics (listed for trauma source; treat 10 days)
References
1. Givner (2002) Pediatr Infect Dis 21:1157

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.