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Cellulitis

What is preseptal cellulitis?

Preseptal cellulitis is swelling of the superficial or anterior portion of the eyelid in front of the septum. The septum is a sheet of connective tissue that separates the anterior superficial eyelid from the orbit (bony socket that contains the eye).

Fig. 1 Preseptal cellulitis due to methicillin-resistant staphylococcus aureus (MRSA)

What are the symptoms of preseptal cellulitis?

The eyelids are swollen and usually red. Eye movements and vision are normal [See figure 1].

What causes preseptal cellulitis?

The swelling/redness results from infection or inflammation. Causes include:

• Sinusitis
• Local spread of infection from other nearby site such as: foreign body, tooth abscess
• Spread of infection from blood
• Insect bite
• Allergic reaction

How is preseptal cellulitis evaluated?

A history and physical is utilized to determine the extent of illness and involvement. Blood may be tested for signs of infection. An imaging study (CT scan or MRI) may be obtained to evaluate for spread beyond the septum into the orbit.

How is preseptal cellulitis treated?

Antibiotic administered by mouth or through an intravenous catheter (for a more serious infection) is indicated when caused by an infection.

A cool compress and antihistamines are used to treat allergy or an insect bite.

What are the complications of preseptal cellulitis?

Infection can spread posteriorly into the orbit or other structures (see orbital cellulitis). Preseptal cellulitis usually responds to proper treatment and there is full recovery.

What is orbital cellulitis?

Orbital cellulitis is infection posterior to the orbital septum. The infection is localized within the eye socket.

What are the symptoms of orbital cellulitis?

The eyelids are swollen and may be red. The eye may be pushed out (proptosis) and have limited movement. Vision in the affected eye may be decreased.

What causes orbital cellulitis?

Spread of infection is the most common cause of orbital cellulitis. Causes include:

• Sinusitis (the most common cause)
• Trauma or foreign body
• Infection from the blood
• Tooth abscess

How is orbital cellulitis evaluated?

A history and physical is utilized to determine the extent of illness and involvement. Blood may be tested for infection. An imaging study (CT scan or MRI) may be obtained to evaluate for spread into and possibly beyond the orbit.

How is orbital cellulitis treated?

Treatment for orbital cellulitis usually involves admission to the hospital for close observation and intravenous antibiotic therapy. Consultation by an Ophthalmologist and possibly an Ear-Nose &Throat specialist are typical. Surgery to drain the infection may be necessary if the condition does not improve or worsens. Loss of vision or evidence of optic nerve involvement may necessitate surgery.

What are the complications of orbital cellulitis?

Spread to surrounding tissue can cause significant worsening of the illness. Spread to the brain from the sinus and orbit may cause a brain abscess (walled off infection), meningitis (infection in tissues surrounding the brain) and/or hydrocephalus (increased pressure in the brain). These serious complications often require intense care and possibly surgical intervention. Rarely, the complications result in death. Orbital cellulitis usually responds to proper treatment and there is full recovery.