Lightning Learning: Orbital Cellulitis

Lightning Learning: Orbital Cellulitis


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.


Consider Ophthalmology and ENT opinions early if concerned.


Eyelid oedema AND erythema OR failure to respond to 48hr abx PLUS one red flag suggests severe infection needing urgent action.

  1. Proptosis or chemosis

  2. Ophthalmoplegia

  3. Relative afferent pupillary defect

  4. Systemically unwell

  5. Painful eye movements

  6. 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.


  1. Watts P. Preseptal and orbital cellulitis in children: a review. Paediatric and Child Health 2011; 22(1):1-8.
  2. Tagg, A. Peri-orbital vs orbital cellulitis, Don't Forget the Bubbles, 2013.
  3. Mathew et al. Paediatric post-septal and pre-septal cellulitis: 10 years’ experience at a tertiary-level children’s hospital. BJR 2013, 87 (1033).
  4. Orbital/Periorbital Cellulitis (PED EM Morsels)
#SimPall: Having The Conversation

#SimPall: Having The Conversation

Lightning Learning: LSD

Lightning Learning: LSD