Periorbital cellulitis Flashcards
What is Peri-orbital cellulitis?
Peri-orbital cellulitis (also called pre-septal cellulitis) is an infection in the eyelid tissues anterior to the orbital septum.
Is peri-orbital cellulitis more or less common than orbital cellulitis?
Peri-orbital cellulitis is a much more common and less serious than orbital cellulitis.
How is peri-orbital cellulitis caused?
Peri-orbital cellulitis is usually caused by superficial injury (e.g. insect bite, chalazion, conjunctivitis) or it can be secondary to upper respiratory tract infections or sinusitis
What are typical symptoms of peri-orbital cellulitis?
Pain, redness and swelling of the eyelid
Fever
What should be covered in a history of peri-orbital cellulitis?
Recent insect bites, styes/chalazions, recent upper respiratory tract infections
Is proptosis a symptom of Peri-Orbital cellulitis?
No ( But is orbital cellulitis)
Table
What are key differences between peri-orbital cellulitis and orbital cellulitis?
Unlike orbital cellulitis, patients with peri-orbital cellulitis are unlikely to experience significant pain.
Visual acuity and visual fields are normal, and there is no pain on eye movement. The patients colour vision will be intact and there will be no sign of chemosis or proptosis. A fever may or may not be present in peri-orbital cellulitis.
Patients with peri-orbital cellulitis are systemically well and symptoms are less severe. If there is severe eyelid swelling it may be difficult to rule out underlying orbital involvement and imaging may be required.
What are the investigations for Peri-Orbital cellulitis?
There are no specific investigations for peri-orbital cellulitis.
If there is any suspicion of orbital cellulitis or the diagnosis is unclear, referral to secondary care for further investigation is required
How should paediatric patients with peri-orbital cellulitis be managed?
Paediatric patients should be urgently referred as they require empirical intravenous antibiotic treatment and daily review due to the difficulty in differentiating between orbital and peri-orbital cellulitis.
What treatment is used for adult patients?
oral co-amoxiclav is usually prescribed first-line (clindamycin if penicillin-allergic). Consider a follow-up review in 24-48 hours and safety netting advice should be provided to the patient.
What are some complications?
Peri-orbital cellulitis can spread to cause orbital cellulitis and its subsequent sequelae. As a result, it is important to provide adequate safety netting advice to patients with peri-orbital cellulitis.
