Preseptal Cellulitis Treatment & Management
- Author: Geoffrey M Kwitko, MD, FACS, FICS; Chief Editor: Edsel Ing, MD, FRCSC more...
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.
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.
The extent of the cutaneous erythema can be outlined with a marking pen or photodocumented to determine progression or improvement on serial evaluation.
Surgical drainage is indicated only for eyelid abscesses and usually is not needed for uncomplicated preseptal cellulitis. Drainage is also indicated in acute dacryocystitis.
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. 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.
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.
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.
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 may be required if otorhinologic or ophthalmologic specialties are not available.
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