Periorbital cellulitis

Background

• Most often due to contiguous infection of soft tissues of face and eyelids
• Most pts 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

1. Swelling and erythema of tissues surrounding the orbit
2. +/- pain with eye movement
3. +/- fever
4. Lack of:
   1. Proptosis
   2. Chemosis
   3. Globe displacement
   4. Limitation of eye movements
   5. Double vision
   6. Vision loss (indicates orbital apex involvement)

Diagnosis

1. CT Orbit with IV contrast if:
   1. Concern for orbital cellulitis
   2. Unable to accurately assess vision (e.g. age <1yr)

Differential Diagnosis

Periorbital swelling

Proptosis

• Normal IOP
  • Orbital cellulitis
  • Orbital pseudotumor
  • Orbital tumor
• Increased IOP
  • Retrobulbar abscess
  • Retrobulbar emphysema
  • Retrobulbar hemorrhage
  • Ocular compartment syndrome
  • 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

Treatment

1. Augmentin 875mg BID x7-10d OR
2. Cefpodoxime 200mg BID x7-10d OR
3. Cefdinir 600mg x7-10d qd

Disposition

• If well-appearing and afebrile consider discharge

See Also

• Periorbital Swelling
• Periorbital vs Orbital Cellulitis
• Orbital Cellulitis

Source

• UpToDate
• Tintinalli