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Preseptal Cellulitis Treatment & Management

  • Author: Geoffrey M Kwitko, MD, FACS, FICS; Chief Editor: Edsel Ing, MD, FRCSC  more...
 
Updated: Jun 16, 2016
 

Approach Considerations

Earlier diagnosis, expeditious treatment, and improved antibiotics have led to a reduction of serious ocular and CNS complications in patients with preseptal cellulitis. Treatment involves management of predisposing conditions, antibiotic therapy, and close observation.[19]

Initial antibiotic therapy is empiric, and, in most cases, a pathogen will not be identified. Given the predisposing factors, antibiotic choice should be directed toward the organisms that cause upper respiratory infections, particularly sinusitis. Specific organisms include Streptococcus pneumoniae, nontypeable H influenzae, and Moraxella catarrhalis. In cases due to focal trauma, treatment should include coverage for S aureus. Methicillin-resistant S aureus (MRSA) should be excluded.[20]

The extent of the cutaneous erythema can be outlined with a marking pen or photodocumented to determine progression or improvement on serial evaluation.

Drainage

Surgical drainage is indicated only for eyelid abscesses[9] and usually is not needed for uncomplicated preseptal cellulitis. Drainage is also indicated in acute dacryocystitis.

Consultations

Consultation should be considered in cases in which the eye cannot be evaluated or if orbital spread is suspected. Ophthalmic consultation and evaluation is recommended for all pediatric patients.[21] Otorhinolaryngology consultation is suggested for medical and surgical treatment of sinusitis and if fungal infection is suspected. Infectious disease consultation is needed in all cases not responding to conservative management.

Outpatient care

If an inpatient responds to empiric antibiotics and can be switched to oral antibiotics, further care can be provided on an outpatient basis. Ambulatory intravenous therapy with daily review is a possible alternative to inpatient admission in patients with pediatric preseptal cellulitis.[22]

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.

Deterrence

The following treatments can discourage the development of preseptal cellulitis:

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

Transfer

Transfer may be required if otorhinologic or ophthalmologic specialties are not available.

 
 
Contributor Information and Disclosures
Author

Geoffrey M Kwitko, MD, FACS, FICS Clinical Associate Professor, Department of Ophthalmology, University of South Florida College of Medicine

Geoffrey M Kwitko, MD, FACS, FICS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, International College of Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

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, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

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

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

Disclosure: Nothing to disclose.

Chief Editor

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

References
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  8. Babar TF, Zaman M, Khan MN, Khan MD. Risk factors of preseptal and orbital cellulitis. J Coll Physicians Surg Pak. 2009 Jan. 19(1):39-42. [Medline].

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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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