Preseptal Cellulitis Follow-up

  • Author: Aaron L Sobol, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Mar 17, 2011
 

Further Inpatient Care

  • If the patient responds to empiric antibiotics and can be switched to oral antibiotics, further care can be provided on an outpatient basis.
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Further Outpatient Care

  • On outpatient follow-up care, the patient should be evaluated for signs of relapse, including fever, erythema, edema, pain, and vision loss.
  • If a history of chronic sinusitis is present, otolaryngology follow-up care should be arranged.
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Inpatient & Outpatient Medications

  • Amoxicillin/clavulanic acid or intramuscular ceftriaxone - Considered for outpatient treatment in selected patients
  • Second- or third-generation cephalosporins - Possible choice for initial empiric therapy
  • Penicillinase resistant synthetic penicillin (eg, nafcillin, oxacillin) - If S aureus is suspected
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Transfer

  • Transfer may be required if otorhinological or ophthalmological specialties are not available.
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Deterrence/Prevention

  • Topical antibiotics may prevent traumatic lid lacerations from becoming infected and causing cellulitis.
  • Adequate treatment of bacterial sinusitis may prevent spread to adjacent tissues.
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Complications

  • Infection may spread along tissue planes to cause subperiosteal abscess, orbital abscess, and cavernous sinus thrombosis.
  • In a study of pediatric patients with intracranial infection, high-risk features included the following: age older than 7 years, subperiosteal abscess, and headache[8] and fever persisting despite IV antibiotics.
  • Patients who are immunocompromised have a higher likelihood of developing fungal infections, which can rapidly become fatal. Aggressive management, including imaging studies of the brain and early IV therapy along with having a low index of suspicion, is indicated for these patients.
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Prognosis

  • If identified and treated promptly, the prognosis for complete recovery without complication is excellent.
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Patient Education

  • Patients should be instructed that loss of vision or pain with eye movements is an indication that the infection has spread to the orbit and may necessitate surgical intervention.
  • For excellent patient education resources, see eMedicine's Diabetes Center. Also, visit eMedicine's patient education article, Cellulitis.
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Contributor Information and Disclosures
Author

Aaron L Sobol, MD  Medical Director, Laurel Ridge Eyecare, Tulane University School of Medicine

Aaron L Sobol, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Kelly A Hutcheson, MD  Associate Professor, Department of Ophthalmology, George Washington University School of Medicine, Children's National Medical Center,

Kelly A Hutcheson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Brian A Phillpotts, MD  Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine

Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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This image shows a 10-year-old child who presented with fever, acute unilateral eyelid erythema, and limited extraocular motions. The presentation is suspicious for orbital cellulitis.
Preseptal cellulitis. This image shows an 8-year-old patient who presented with unilateral eyelid swelling and erythema.
 
 
 
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