Periorbital cellulitis
Background
- Most often due to contiguous infection of soft tissues of face and eyelids
- Most patients are <10yr
- Rarely leads to orbital cellulitis
Periorbital vs Orbital Cellulitis
- Orbital cellulitis may mimic periorbital cellulitis early in its course
- Orbital cellulitis
- Ocular emergency
- Most often due to ethmoid sinusitis
- May also be due to orbital trauma, endophthalmitis, infection from teeth / middle ear
- Not caused by extension of periorbital cellulitis
- Periorbital cellulitis
- Usually benign
- Most often due to contiguous infection of soft tissues of face and eyelids
Clinical Features
- Swelling, tenderness, and erythema of eyelids and superficial tissues surrounding the orbit
- +/- fever
- Lack of:
- Proptosis
- Chemosis
- Globe displacement
- Limitation of eye movements
- Pain with eye movement
- Double vision
- Vision loss (indicates orbital apex involvement)
Differential Diagnosis
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Evaluation
Periorbital cellulitis caused by a dental infection (also causing maxillary sinusitis).
- CT Orbit with IV contrast if:
- Concern for orbital cellulitis-i.e. equivocal assessment of proptosis, red eye, EOM function or pain w/ eye movement
- Unable to accurately assess vision (e.g. age <1yr)
Management
Antibiotics
Outpatient
- Amoxicillin/Clavulanate 875mg BID x7-10 days OR
- Cefpodoxime 200mg BID x7-10d OR
- Cephalexin 450mg PO three times daily OR
- Cefdinir 600mg PO once daily x7-10 days
Inpatient
Vancomycin 15-20mg/kg IV BID + (one of the following)
- Ampicillin/Sulbactam 3 g IV q6hr OR
- Ticarcillin/Clavulanate 3.1 g IV q4h OR
- Piperacillin-Tazobactam 4.5 g IV q6h OR
- Ceftriaxone 2 g IV q12hr OR
- Cefotaxime 2 g IV q4h
Disposition
- If well-appearing and afebrile consider discharge
References
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