Preseptal Cellulitis

1. Pathophysiology
   1. Fibrous membrane extends from orbit rim to lid margin
      1. Septum prevents extension or lid disease to orbit
2. Epidemiology
   1. Typical onset at age 18 months to 3 years
3. 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
4. Organisms
   1. Trauma
      1. Staphylococcus aureus
      2. Group A Streptococcus
   2. Bacteremia
      1. Streptococcus Pneumoniae
5. 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
6. Complications
   1. Intracerebral extension of Preseptal Cellulitis rare
      1. Protective fibrous layer prevents extension
7. Differential Diagnosis
   1. See Eyelid Inflammation
   2. Orbital Cellulitis
8. 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)
      1. Cephalexin
      2. Dicloxacillin
      3. Clindamycin
9. References
   1. Givner (2002) Pediatr Infect Dis 21:1157-8