preseptal/periorbital cellulitis

Question 1

what is preseptal / periorbital cellulitis?

Answer 1

infection of the soft tissues anterior to the orbital septum (eyelids, skin and subcutaneous tissue of the face BUT not the contents of the orbit)

Question 2

what is orbital cellulitis?

Answer 2

infection of the soft tissues behind the orbital septum

= much more SERIOUS infection

Question 3

where and how does infection in preseptal cellulitis usually spread?

Answer 3

usually spreads to structures surrounding the orbit from other nearby sites, most commonly from breaks in the skin or local infections e.g. sinusitis or resp tract infections

Question 4

what are the most frequently causative organisms in preseptal cellulitis?

Answer 4

1. staph. aureus
2. staph. epidermidis
3. streptococci
4. anaerobic bacteria

Question 5

in whom does preseptal cellulitis usually occur in?

Answer 5

children (80% pts are <10 y.o.)

more common in winter due to increased prevalence of resp tract infections

Question 6

what do pts with preseptal cellulitis present with?

Answer 6

red, swollen, painful eye of acute onset

sx associated w fever

Question 7

what signs can you see on preseptal cellulitis?

Answer 7

1. erythema and oedema of eyelids, can spread into surrounding skin
2. partial/complete ptosis due to swelling
3. orbital signs ABSENT - their presence would indicate orbital cellulitis

Question 8

what are important differentials you must consider for preseptal cellulitis?

Answer 8

1. orbital cellulitis
2. allergic reaction

Question 9

how do you investigate for preseptal cellulitis?

Answer 9

1. bloods - raised inflammatory markers
2. swab any discharge
3. contrast CT of the orbit - to differentiate between preseptal and orbital cellulitis. should be performed in all pts suspected to have orbital cellulitis.

Question 10

how should preseptal cellulitis be managed?

Answer 10

1. all cases should be referred to secondary care for assessment
2. oral abx - usually co-amoxiclav
3. children may require admission for obs

Question 11

what are the complications of preseptal cellulitis?

Answer 11

bacterial infection may spread into the orbit and evolve into orbital cellulitis

Question 12

what are the orbital signs seen in orbital cellulitis?

Answer 12

1. pain on movement of the eye
2. restriction of eye movements
3. proptosis
4. visual disturbance
5. chemosis _{^{(swelling/oedema of conjuctiva)}}
6. RAPD