Preseptal Cellulitis Treatment & Management

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

Medical Care

Treatment involves management of predisposing conditions, antibiotic therapy, and close observation.[6]

  • 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.
    • In older children or adults with mild preseptal cellulitis, outpatient treatment may be considered with amoxicillin/clavulanic acid or a first-generation cephalosporin. Outpatient management with intramuscular ceftriaxone also is possible. If the patient fails to respond within 48-72 hours, consider intravenous antibiotics.
    • In younger children or in more severe cases, admission for close observation and intravenous antibiotics are standard. Many published regimens exist for empiric therapy, but no regimen has been tested in clinical trials. A second- or third-generation cephalosporin (eg, cefuroxime, ceftriaxone) provides adequate coverage, even with resistant S pneumoniae. If anaerobes or S aureus are suspected, then clindamycin with a cephalosporin provides coverage. Other primary antibiotics include penicillinase-resistant synthetic penicillins (eg, nafcillin, oxacillin), especially if S aureus is suspected.
    • Clinical improvement should be seen within 24-48 hours. If the patient worsens, then consider an underlying orbital process or resistant organisms.
    • After clinical improvement on 48-72 hours of intravenous antibiotics is demonstrated, a trial of oral antibiotics for 24 hours can be tried. If the clinical improvement continues, the patient can be observed on an outpatient basis. Oral antibiotics should be continued for 10 days. Such conservative treatment strategies are recommended, particularly for pediatric patients.
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Surgical Care

Surgical drainage is indicated only for eyelid abscesses[2] and usually is not needed for uncomplicated preseptal cellulitis.

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Consultations

  • Consultation should be considered in cases where the eye cannot be evaluated or if orbital spread is suspected. Ophthalmic consultation and evaluation is recommended for all pediatric patients.[7]
  • Otorhinolaryngology consultation is suggested for medical and surgical treatment of sinusitis.
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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

  1. Artac H, Silahli M, Keles S, Ozdemir M, Reisli I. A rare cause of preseptal cellulitis: anthrax. Pediatr Dermatol. May-Jun 2007;24(3):330-1. [Medline].

  2. Chaudhry IA, Shamsi FA, Elzaridi E, Al-Rashed W, Al-Amri A, Arat YO. Inpatient preseptal cellulitis: experience from a tertiary eye care centre. Br J Ophthalmol. Oct 2008;92(10):1337-41. [Medline].

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

  4. Finger Basak SA, Berk DR, Lueder GT, Bayliss SJ. Common features of periocular tinea. Arch Ophthalmol. Mar 2011;129(3):306-9. [Medline].

  5. Ho CF, Huang YC, Wang CJ, Chiu CH, Lin TY. Clinical analysis of computed tomography-staged orbital cellulitis in children. J Microbiol Immunol Infect. Dec 2007;40(6):518-24. [Medline].

  6. Liu IT, Kao SC, Wang AG, Tsai CC, Liang CK, Hsu WM. Preseptal and orbital cellulitis: a 10-year review of hospitalized patients. J Chin Med Assoc. Sep 2006;69(9):415-22. [Medline].

  7. Yang M, Quah BL, Seah LL, Looi A. Orbital cellulitis in children-medical treatment versus surgical management. Orbit. 2009;28(2-3):124-36. [Medline].

  8. Murthum K, Pogorelov P, Bergua A. [Preseptal cellulitis as a complication of surgical treatment of migraine headaches]. Klin Monatsbl Augenheilkd. Jul 2009;226(7):572-3. [Medline].

  9. Adams WG, Deaver KA, Cochi SL, Plikaytis BD, Zell ER, Broome CV, et al. Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era. JAMA. Jan 13 1993;269(2):221-6. [Medline].

  10. Agarwal M, Biswas J, S K, Shanmugam MP. Retinoblastoma presenting as orbital cellulitis: report of four cases with a review of the literature. Orbit. Jun 2004;23(2):93-8. [Medline].

  11. Ambati BK, Ambati J, Azar N, Stratton L, Schmidt EV. Periorbital and orbital cellulitis before and after the advent of Haemophilus influenzae type B vaccination. Ophthalmology. Aug 2000;107(8):1450-3. [Medline].

  12. Barone SR, Aiuto LT. Periorbital and orbital cellulitis in the Haemophilus influenzae vaccine era. J Pediatr Ophthalmol Strabismus. Sep-Oct 1997;34(5):293-6. [Medline].

  13. Donahue SP, Schwartz G. Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum. Ophthalmology. Oct 1998;105(10):1902-5; discussion 1905-6. [Medline].

  14. Eustis HS, Armstrong DC, Buncic JR, Morin JD. Staging of orbital cellulitis in children: computerized tomography characteristics and treatment guidelines. J Pediatr Ophthalmol Strabismus. Sep-Oct 1986;23(5):246-51. [Medline].

  15. Hirsch M, Lifshitz T. Computerized tomography in the diagnosis and treatment of orbital cellulitis. Pediatr Radiol. 1988;18(4):302-5. [Medline].

  16. Hu G, Wang MJ, Miller MJ, Holland GN, Bruckner DA, Civen R, et al. Ocular vaccinia following exposure to a smallpox vaccinee. Am J Ophthalmol. Mar 2004;137(3):554-6. [Medline].

  17. Jackson K, Baker SR. Periorbital cellulitis. Head Neck Surg. Mar-Apr 1987;9(4):227-34. [Medline].

  18. Jacobs D, Galetta S. Diagnosis and management of orbital pseudotumor. Curr Opin Ophthalmol. Dec 2002;13(6):347-51. [Medline].

  19. Malinow I, Powell KR. Periorbital cellulitis. Pediatr Ann. Apr 1993;22(4):241-6. [Medline].

  20. McCarty ML, Wilson MW, Fleming JC, Thompson JW, Sandlund JT, Flynn PM, et al. Manifestations of fungal cellulitis of the orbit in children with neutropenia and fever. Ophthal Plast Reconstr Surg. May 2004;20(3):217-23. [Medline].

  21. Molarte AB, Isenberg SJ. Periorbital cellulitis in infancy. J Pediatr Ophthalmol Strabismus. Sep-Oct 1989;26(5):232-4; discussion 235. [Medline].

  22. Reynolds DJ, Kodsi SR, Rubin SE, Rodgers IR. Intracranial infection associated with preseptal and orbital cellulitis in the pediatric patient. J AAPOS. Dec 2003;7(6):413-7. [Medline].

  23. Ruttum MS, Ogawa G. Adenovirus conjunctivitis mimics preseptal and orbital cellulitis in young children. Pediatr Infect Dis J. Mar 1996;15(3):266-7. [Medline].

  24. Schwartz GR, Wright SW. Changing bacteriology of periorbital cellulitis. Ann Emerg Med. Dec 1996;28(6):617-20. [Medline].

  25. Soysal HG, Kiratli H, Recep OF. Anthrax as the cause of preseptal cellulitis and cicatricial ectropion. Acta Ophthalmol Scand. Apr 2001;79(2):208-9. [Medline].

  26. Weiss A, Friendly D, Eglin K, Chang M, Gold B. Bacterial periorbital and orbital cellulitis in childhood. Ophthalmology. Mar 1983;90(3):195-203. [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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