Lightning Learning: Orbital Cellulitis
STOP!
Periorbital infections involve the soft tissues surrounding the globe of the eye. Whilst preseptal cellulitis is less dangerous than postseptal any pressure or breach to orbit can endanger the eye.
Preseptal cellulitis is common, resulting from scratches, insect bites or local spread of infection (URTI, blepharitis, conjunctivitis).
Postseptal/orbital cellulitis arises from secondary spread (sinusitis, local trauma and rarely via blood). Complications include abscesses and cavernous sinus thrombosis.
ORBITAL CELLULITIS IS AN EMERGENCY!
Consider Ophthalmology and ENT opinions early if concerned.
LOOK
Eyelid oedema AND erythema OR failure to respond to 48hr abx PLUS one red flag suggests severe infection needing urgent action.
Proptosis or chemosis
Ophthalmoplegia
Relative afferent pupillary defect
Systemically unwell
Painful eye movements
Altered visual acuity or blurring
Severe infection warrants bloods, blood cultures, IV abx, admission +/- urgent CT imaging especially if red flags, or any of the following...
Disturbed colour vision
Severe swelling
Neurological signs
Poor progress or swinging pyrexia despite >24 hrs IV abx
Surgical drainage may be required if no improvements are seen.
LEARN
- Watts P. Preseptal and orbital cellulitis in children: a review. Paediatric and Child Health 2011; 22(1):1-8.
- Tagg, A. Peri-orbital vs orbital cellulitis, Don't Forget the Bubbles, 2013.
- Mathew et al. Paediatric post-septal and pre-septal cellulitis: 10 years’ experience at a tertiary-level children’s hospital. BJR 2013, 87 (1033).
- Orbital/Periorbital Cellulitis (PED EM Morsels)
