Orbital Cellulitis & Preseptal Cellulitis

Question 1

What is orbital cellulitis?

Answer 1

Infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe.

Question 2

What is the cause of orbital cellulitis?

Answer 2

Spreading upper respiratory tract infection from the sinuses and carries a high mortality rate.

Question 3

What is the prognosis?

Answer 3

Medical emergency, hospital admission and urgent senior review.

Question 4

What is periorbital/preseptal cellulitis?

Answer 4

Less serious superficial infection anterior to the orbital septum, resulting from a superficial tissue injury (chalazion, insect bite ect)
(Eyelids, skin and SC tissue of the face)

Question 5

What is the epidemiology of orbital cellulitis and periorbital cellulitis?

Answer 5

Orbital: Mean age of hospitalisation is 7-12 years
Periorbital: median age 2 years

Question 6

What are the risk factors of orbital cellulitis?

Answer 6

Childhood
Previous sinus infection 
Lack of Hib vaccination
Recent eyelid infection/ insect bite on the eyelid
Ear or facial infection

Question 7

What is the presentation of orbital cellulitis?

Answer 7

Redness and swelling around the eye
Severe ocular pain
Visual disturbance
Proptosis
Opthalmoplegia/pain with eye movements
Eyelid oedema and ptosis
Drowsiness +/- nausea and vomitting

Question 8

How can orbital and preseptal cellulitis be differentiated?

Answer 8

Reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis

Question 9

What are the investigations for orbital cellulitis?

Answer 9

Full blood count – WBC elevated, raised inflammatory markers.
Clinical examination involving complete ophthalmological assessment – Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema.
CT with contrast – Inflammation of the orbital tissues deep to the septum, sinusitis.
Blood culture and microbiological swab to determine the organism. Most common bacterial causes – Streptococcus, Staphylococcus aureus, Haemophilus influenzae B.

Question 10

What is the management of orbital cellulitis?

Answer 10

Admission to hospital for IV antibiotics

Question 11

What organisms most commonly cause periorbital/preseptal cellulitis?

Answer 11

Staph. aureus
Staph. epidermis
Streptococci

Question 12

What are the symptoms of periorbital cellulitis?

Answer 12

Red, swollen, painful eye of acute onset, symptoms associated with fever

Question 13

What are the signs of periorbital cellulitis?

Answer 13

Erythema and oedema of the eyelids
Ptosis due to swelling

MUST BE ABSENT
Orbital signs: pain on movement, restriction of eye movements, proptosis, visual distrubance, chemosis, RAPD.
ONLY PRESENT IN ORBITAL CELLULITIS

Question 14

What are the differential diagnosis for periorbital cellulitis?

Answer 14

Orbital cellulitis

Allergic reaction

Question 15

What are the investigations for periorbital cellulitis?

Answer 15

Bloods - raised inflammatory markers
Swab of any discharge
Contrast CT of the orbit may help to differentiate between orbital and periorbital cellulitis.

Question 16

What is the management of periorbital cellulitis?

Answer 16

All cases should be referred to secondary care for assessment
Oral antibiotics are frequently sufficient - usually co-amoxiclav
Children may require admission

Question 17

What are the complications of periorbital cellulitis?

Answer 17

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