Periorbital and Orbital Cellulitis

Definition | Periorbital Cellulitis | Orbital Cellulitis | References

Definition

Periorbital and orbital cellulitis are infections involving the tissues surrounding the eye. Periorbital cellulitis, also known as preseptal cellulitis, affects the eyelid and surrounding skin, while orbital cellulitis involves the eye socket and can threaten vision and life.

Periorbital Cellulitis

Definition: Periorbital cellulitis is an infection of the eyelid and periocular tissues anterior to the orbital septum.

Aetiology: Commonly caused by bacterial infections, often secondary to local trauma, insect bites, or adjacent sinusitis. The most common pathogens are Staphylococcus aureus and Streptococcus species.

Pathophysiology: The infection leads to inflammation and swelling of the eyelid and surrounding tissues without involving the orbital contents.

Risk Factors: Sinusitis, trauma to the eyelid, insect bites, upper respiratory infections.

Signs and Symptoms:

• Redness and swelling of the eyelid
• Pain and tenderness around the eye
• Fever
• Absence of proptosis, ophthalmoplegia, and visual impairment (distinguishing from orbital cellulitis)

Investigations:

• Clinical history and physical examination
• Blood tests to check for signs of infection
• Imaging (CT scan) if there is concern about progression to orbital cellulitis

Management:

Primary Care Management

• Oral antibiotics: Empirical treatment with agents effective against common pathogens (e.g., co-amoxiclav)
• Pain management: Oral analgesics such as paracetamol or ibuprofen
• Close monitoring for signs of progression to orbital cellulitis
• Referral to secondary care if there is no improvement or if orbital cellulitis is suspected

Orbital Cellulitis

Definition: Orbital cellulitis is a serious infection involving the fat and muscles within the orbit, posterior to the orbital septum.

Aetiology: Commonly caused by bacterial spread from adjacent sinuses, particularly ethmoid sinusitis. The most common pathogens are Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae.

Pathophysiology: The infection can cause significant inflammation, leading to increased intraorbital pressure and potential complications such as abscess formation, vision loss, and intracranial spread.

Risk Factors: Sinusitis, recent upper respiratory infections, trauma, immunocompromised states.

Signs and Symptoms:

• Redness and swelling of the eyelid
• Proptosis (protrusion of the eyeball)
• Pain with eye movement
• Ophthalmoplegia (restricted eye movement)
• Visual impairment
• Fever

Investigations:

• Clinical history and physical examination
• Blood tests to check for signs of infection
• Imaging (CT or MRI scan) to assess the extent of the infection and any complications
• Microbiological culture of any discharge or blood

Management:

Primary Care Management

• Immediate referral to hospital: Orbital cellulitis is a medical emergency and requires urgent specialist management

Specialist Management

• Intravenous antibiotics: Broad-spectrum antibiotics initially, then tailored based on culture results (e.g., ceftriaxone, metronidazole)
• Intravenous fluids: To maintain hydration and support systemic health
• Surgical intervention: If there is an abscess or if the infection does not respond to medical treatment
• Regular ophthalmological assessments to monitor for complications
• Management of any underlying conditions (e.g., sinusitis)

References

1. NICE. (2024). Periorbital and Orbital Cellulitis: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Periorbital and Orbital Cellulitis. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Periorbital and Orbital Cellulitis: Diagnosis and Management. Retrieved from BMJ
4. Patient.info. (2023). Periorbital and Orbital Cellulitis: Causes and Treatment. Retrieved from Patient.info

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