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Periorbital Infections Differential Diagnoses

  • Author: Bobak Zonnoor , MD; Chief Editor: Robert E O'Connor, MD, MPH  more...
 
Updated: Dec 02, 2015
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of periorbital cellulitis include the following:

  • Angioedema
  • Insect bites
  • Cavernous sinus thrombosis
  • Chalazion
  • Internal and external hordeola
  • Idiopathic orbital inflammation (orbital pseudotumor)[55]
  • Mucormycosis
  • Nephrotic syndrome
  • Orbital cellulitis
  • Pott's puffy tumor[56, 57]
  • Periorbital necrotizing fasciitis

Conditions to consider in the differential diagnosis of blepharitis include the following[58] :

  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Sebaceous cell carcinoma
  • Actinic keratosis
  • Keratoacanthoma

Conditions to consider in the differential diagnosis of dacryoadenitis include the following:

  • Sjögren syndrome
  • Sarcoidosis
  • Tumors - Cause about 25% of lacrimal gland enlargement[59]

Conditions to consider in the differential diagnosis of canaliculitis include the following:

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Bobak Zonnoor , MD Resident Physician, Department of Emergency Medicine, SUNY Downstate Medical Center, Kings County Hospital

Bobak Zonnoor , MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth Fiedler, MD Clinical Instructor, Department of Emergency Medicine, Montefiore Medical Center-Weiler Division

Elizabeth Fiedler, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Zach Kassutto, MD, FAAP Director, Pediatric Emergency Medicine, Capital Health System; Associate Professor of Pediatrics and Emergency Medicine, Drexel University College of Medicine; Attending Physician, St Christopher's Hospital for Children

Zach Kassutto, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Association for Physician Leadership, American Heart Association, Medical Society of Delaware, Society for Academic Emergency Medicine, Wilderness Medical Society, American Medical Association, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Additional Contributors

R Gentry Wilkerson, MD, FACEP, FAAEM Assistant Professor, Coordinator for Research, Department of Emergency Medicine, University of Maryland School of Medicine

R Gentry Wilkerson, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Edmond A Hooker II, MD, DrPH, FAAEM Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. Givner LB, Mason EO Jr, Barson WJ, et al. Pneumococcal facial cellulitis in children. Pediatrics. 2000 Nov. 106(5):E61. [Medline].

  2. Moubayed SP, Vu TT, Quach C, Daniel SJ. Periorbital cellulitis in the pediatric population: clinical features and management of 117 cases. J Otolaryngol Head Neck Surg. 2011 Jun. 40(3):266-70. [Medline].

  3. Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970 Sep. 80(9):1414-28. [Medline].

  4. Chin RL. Emergency Management of Infectious Diseases. Cambridge University Press; 2008. 151.

  5. Gershon. Krugman's Infectious Diseases of Children. 11th ed. 2004. (MD Consult) [pg 163-4].

  6. American Academy of Ophthalmology. Blepharitis Fact Sheet. Accessed December 3, 2009.

  7. Yanoff. Ophthalmology [MD Consult]. 2nd ed. 2004. chap 82, 98.

  8. Givner LB. Periorbital versus orbital cellulitis. Pediatr Infect Dis J. 2002 Dec. 21(12):1157-8. [Medline].

  9. Brook I. Microbiology of acute sinusitis of odontogenic origin presenting with periorbital cellulitis in children. Ann Otol Rhinol Laryngol. 2007 May. 116(5):386-8. [Medline].

  10. Charalampidou S, Connell P, Fennell J, et al. Preseptal cellulitis caused by community acquired methicillin resistant Staphylococcus aureus (CAMRSA). Br J Ophthalmol. 2007 Dec. 91(12):1723-4. [Medline].

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

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

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

  14. Green JA, Lim J, Barkham T. Neisseria gonorrhoeae: a rare cause of preseptal cellulitis?. Int J STD AIDS. 2006 Feb. 17(2):137-8. [Medline].

  15. Chand DV, Hoyen CK, Leonard EG, et al. First reported case of Neisseria meningitidis periorbital cellulitis associated with meningitis. Pediatrics. 2005 Dec. 116(6):e874-5. [Medline].

  16. Porras MC, Martínez VC, Ruiz IM, et al. Acute cellulitis: an unusual manifestation of meningococcal disease. Scand J Infect Dis. 2001. 33(1):56-9. [Medline].

  17. Lewis FM, Chernak E, Goldman E, et al. Ocular vaccinia infection in laboratory worker, Philadelphia, 2004. Emerg Infect Dis. 2006 Jan. 12(1):134-7. [Medline].

  18. Fillmore GL, Ward TP, Bower KS, et al. Ocular complications in the Department of Defense Smallpox Vaccination Program. Ophthalmology. 2004 Nov. 111(11):2086-93. [Medline].

  19. Raina UK, Jain S, Monga S, et al. Tubercular preseptal cellulitis in children: a presenting feature of underlying systemic tuberculosis. Ophthalmology. 2004 Feb. 111(2):291-6. [Medline].

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

  21. Kohli V, Gaur S, Deen M, Engel M, Shah K. Orbital cysticercosis presenting as recurrent periorbital cellulitis in a four-year-old child. Pediatr Infect Dis J. 2010 May. 29(5):481. [Medline].

  22. Noble. Textbook of Primary Care Medicine [MD Consult]. 3rd ed. 2001. 1693.

  23. Rubin M, Rao SN. Efficacy of topical cyclosporin 0.05% in the treatment of posterior blepharitis. J Ocul Pharmacol Ther. 2006 Feb. 22(1):47-53. [Medline].

  24. Lee SH, Oh DH, Jung JY, Kim JC, Jeon CO. Comparative ocular microbial communities in humans with and without blepharitis. Invest Ophthalmol Vis Sci. 2012 Aug 15. 53(9):5585-93. [Medline].

  25. Wald ER. Periorbital and orbital infections. Infect Dis Clin North Am. 2007 Jun. 21(2):393-408, vi. [Medline].

  26. American Academy of Ophthalmology. Preferred Practice Patterns: Blepharitis. Accessed December 3, 2009.

  27. Jackson WB. Blepharitis: current strategies for diagnosis and management. Can J Ophthalmol. 2008 Apr. 43(2):170-9. [Medline].

  28. Sacca SC, Pascotto A, Venturino GM, et al. Prevalence and treatment of Helicobacter pylori in patients with blepharitis. Invest Ophthalmol Vis Sci. 2006 Feb. 47(2):501-8. [Medline].

  29. Kheirkhah A, Casas V, Li W, et al. Corneal manifestations of ocular demodex infestation. Am J Ophthalmol. 2007 May. 143(5):743-749. [Medline].

  30. Thappa DM, Karthikeyan K, Jeevankumar B. Phthiriasis palpebrarum. Postgrad Med J. 2003 Feb. 79(928):102. [Medline].

  31. Mathers WD, Shields WJ, Sachdev MS, Petroll WM, Jester JV. Meibomian gland dysfunction in chronic blepharitis. Cornea. 1991 Jul. 10(4):277-85. [Medline].

  32. Seal DV, McGill JI, Jacobs P, Liakos GM, Goulding NJ. Microbial and immunological investigations of chronic non-ulcerative blepharitis and meibomianitis. Br J Ophthalmol. 1985 Aug. 69(8):604-11. [Medline].

  33. Lee S, Tsirbas A, McCann JD, et al. Mikulicz's disease: a new perspective and literature review. Eur J Ophthalmol. 2006 Mar-Apr. 16(2):199-203. [Medline].

  34. Rhem MN, Wilhelmus KR, Jones DB. Epstein-Barr virus dacryoadenitis. Am J Ophthalmol. 2000 Mar. 129(3):372-5. [Medline].

  35. Mills DM, Bodman MG, Meyer DR, et al. The microbiologic spectrum of dacryocystitis: a national study of acute versus chronic infection. Ophthal Plast Reconstr Surg. 2007 Jul-Aug. 23(4):302-6. [Medline].

  36. Bharathi MJ, Ramakrishnan R, Maneksha V, Shivakumar C, Nithya V, Mittal S. Comparative bacteriology of acute and chronic dacryocystitis. Eye (Lond). 2008 Jul. 22(7):953-60. [Medline].

  37. Kapur R, Aakalu VK, August CZ, Weiss RA. Mucormycosis infection of the lacrimal sac. Ophthal Plast Reconstr Surg. 2009 Nov-Dec. 25(6):494-6. [Medline].

  38. Lee J, Flanagan JC. Complications associated with silicone intracanalicular plugs. Ophthal Plast Reconstr Surg. 2001 Nov. 17(6):465-9. [Medline].

  39. Zaldívar RA, Bradley EA. Primary canaliculitis. Ophthal Plast Reconstr Surg. 2009 Nov-Dec. 25(6):481-4. [Medline].

  40. Anand S, Hollingworth K, Kumar V, et al. Canaliculitis: the incidence of long-term epiphora following canaliculotomy. Orbit. 2004 Mar. 23(1):19-26. [Medline].

  41. Varma D, Chang B, Musaad S. A case series on chronic canaliculitis. Orbit. 2005 Mar. 24(1):11-4. [Medline].

  42. Moscato EE, Sires BS. Atypical canaliculitis. Ophthal Plast Reconstr Surg. 2008 Jan-Feb. 24(1):54-5. [Medline].

  43. Hauser A, Fogarasi S. Periorbital and orbital cellulitis. Pediatr Rev. 2010 Jun. 31 (6):242-9. [Medline].

  44. Lazzeri D, Lazzeri S, Figus M, Tascini C, Bocci G, Colizzi L, et al. Periorbital Necrotizing Fasciitis. Br J Ophthalmol. 2009 Nov 5. [Medline].

  45. Ataullah S, Sloan B. Acute dacryocystitis presenting as an orbital abscess. Clin Experiment Ophthalmol. 2002 Feb. 30(1):44-6. [Medline].

  46. Botting AM, McIntosh D, Mahadevan M. Paediatric pre- and post-septal peri-orbital infections are different diseases. A retrospective review of 262 cases. Int J Pediatr Otorhinolaryngol. 2008 Mar. 72 (3):377-83. [Medline].

  47. McKinley SH, Yen MT, Miller AM, Yen KG. Microbiology of pediatric orbital cellulitis. Am J Ophthalmol. 2007 Oct. 144 (4):497-501. [Medline].

  48. 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. 2006 Sep. 69 (9):415-22. [Medline].

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

  50. Friedlaender MH. Blepharitis, allergy, and dry eye: lumpers and splitters. Ann Ophthalmol (Skokie). 2006 Spring. 38(1):4-5. [Medline].

  51. Thirumoorthi MC, Asmar BI, Dajani AS. Violaceous discoloration in pneumococcal cellulitis. Pediatrics. 1978 Oct. 62(4):492-3. [Medline].

  52. Carter SR. Eyelid disorders: diagnosis and management. Am Fam Physician. 1998 Jun. 57(11):2695-702. [Medline].

  53. Farpour B, McClellan KA. Diagnosis and management of chronic blepharokeratoconjunctivitis in children. J Pediatr Ophthalmol Strabismus. 2001 Jul-Aug. 38(4):207-12. [Medline].

  54. Wald ER. Periorbital and orbital infections. Pediatr Rev. 2004 Sep. 25(9):312-20. [Medline].

  55. Yuen SJ, Rubin PA. Idiopathic orbital inflammation: distribution, clinical features, and treatment outcome. Arch Ophthalmol. 2003 Apr. 121(4):491-9. [Medline].

  56. Lamoreau KP, Fanciullo LM. Pott’s Puffy Tumor Mimicking Preseptal Cellulitis. Clin Exp Opt 2007; Published early online. Accessed 15 March, 2008.

  57. Morley AM. Pott's puffy tumour: a rare but sinister cause of periorbital oedema in a child. Eye (Lond). 2009 Apr. 23(4):990-1. [Medline].

  58. Swann PG, Weir J. Is it blepharitis?. Clin Exp Optom. 2005 Mar. 88(2):113-4. [Medline].

  59. Boruchoff SA, Boruchoff SE. Infections of the lacrimal system. Infect Dis Clin North Am. 1992 Dec. 6(4):925-32. [Medline].

  60. Charles NC, Lisman RD, Mittal KR. Carcinoma of the lacrimal canaliculus masquerading as canaliculitis. Arch Ophthalmol. 2006 Mar. 124(3):414-6. [Medline].

  61. Howe L, Jones NS. Guidelines for the management of periorbital cellulitis/abscess. Clin Otolaryngol Allied Sci. 2004 Dec. 29(6):725-8. [Medline].

  62. Rudloe TF, Harper MB, Prabhu SP, Rahbar R, Vanderveen D, Kimia AA. Acute periorbital infections: who needs emergent imaging?. Pediatrics. 2010 Apr. 125(4):e719-26. [Medline].

  63. Cortez O, Schaeffer CJ, Hatem SF, Glauser J, Ahmed M. Cases from the Cleveland Clinic: cerebral venous sinus thrombosis presenting to the emergency department with worst headache of life. Emerg Radiol. 2009 Jan. 16(1):79-82. [Medline].

  64. Tost F, Bruder R, Clemens S. Clinical diagnosis of chronic canaliculitis by 20-MHz ultrasound. Ophthalmologica. 2000. 214(6):433-6. [Medline].

  65. O'Donnell BA, Clement CI. Assessing patients with epiphora who are patent to syringing: clinical predictors of response to dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2007 May-Jun. 23(3):173-8. [Medline].

  66. Al-Nammari S, Roberton B, Ferguson C. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Should a child with preseptal periorbital cellulitis be treated with intravenous or oral antibiotics?. Emerg Med J. 2007 Feb. 24 (2):128-9. [Medline].

  67. American Academy of Pediatrics. Subcommittee on Management of Sinusitis and Committee on Quality Improvement. Clinical practice guideline: management of sinusitis. Pediatrics. 2001 Sep. 108 (3):798-808. [Medline].

  68. Vu BL, Dick PT, Levin AV, et al. Development of a clinical severity score for preseptal cellulitis in children. Pediatr Emerg Care. 2003 Oct. 19(5):302-7. [Medline].

  69. Thikkurissy S, Rawlins JT, Kumar A, Evans E, Casamassimo PS. Rapid treatment reduces hospitalization for pediatric patients with odontogenic-based cellulitis. Am J Emerg Med. 2010 Jul. 28(6):668-72. [Medline].

  70. Upile NS, Munir N, Leong SC, et al. Who should manage acute periorbital cellulitis in children?. Int J Pediatr Otorhinolaryngol. Aug 2012. 76(8):1073-7. [Medline].

  71. Viswalingam M, Rauz S, Morlet N, et al. Blepharokeratoconjunctivitis in children: diagnosis and treatment. Br J Ophthalmol. 2005 Apr. 89(4):400-3. [Medline].

  72. Yactayo-Miranda Y, Ta CN, He L, Kreutzer TC, Nentwich MM, Kampik A, et al. A prospective study determining the efficacy of topical 0.5% levofloxacin on bacterial flora of patients with chronic blepharoconjunctivitis. Graefes Arch Clin Exp Ophthalmol. 2009 Jul. 247(7):993-8. [Medline].

  73. American Academy of Ophthalmology. Preferred Practice Patterns: Blepharitis. Available at: http://one.aao.org. Accessed March 14, 2008.

  74. Belfort R Jr, Gabriel L, Martins Bispo PJ, Muccioli C, Zacharias Serapicos PC, Clark L, et al. Safety and efficacy of moxifloxacin-dexamethasone eyedrops as treatment for bacterial ocular infection associated with bacterial blepharitis. Adv Ther. 2012 May. 29(5):416-26. [Medline].

  75. Luchs J. Efficacy of topical azithromycin ophthalmic solution 1% in the treatment of posterior blepharitis. Adv Ther. 2008 Sep. 25(9):858-70. [Medline].

  76. Bezdetko PA, Sergienko N, Dyomin Y, Korol A, Nikitin N, Merzbacher M, et al. Successful treatment of blepharitis with bibrocathol (Posiformin(®) 2 %). Graefes Arch Clin Exp Ophthalmol. 2012 Apr 25. [Medline].

  77. Castanheira M, Watters AA, Bell JM, Turnidge JD, Jones RN. Fusidic Acid Resistance Rates and Prevalence of Resistance Mechanisms Among Staphylococcus spp. isolated in North America and Australia (2007-2008). Antimicrob Agents Chemother. 2010 Jun 21. [Medline].

  78. Knezevic T, Ivekovic R, Astalos JP, Novak Laus K, Mandic Z, Matejcic A. Botulinum toxin A injection for primary and recurrent chalazia. Graefes Arch Clin Exp Ophthalmol. 2009 Jun. 247(6):789-94. [Medline].

  79. Gao YY, Di Pascuale MA, Elizondo A, Tseng SC. Clinical treatment of ocular demodecosis by lid scrub with tea tree oil. Cornea. 2007 Feb. 26(2):136-43. [Medline].

  80. Pinckney J 2nd, Cole P, Vadapalli SP, Rosen T. Phthiriasis palpebrarum: a common culprit with uncommon presentation. Dermatol Online J. 2008. 14(4):7. [Medline].

  81. Aburn NS, Sullivan TJ. Infectious mononucleosis presenting with dacryoadenitis. Ophthalmology. 1996 May. 103(5):776-8. [Medline].

  82. Greenberg MF, Pollard ZF. The red eye in childhood. Pediatr Clin North Am. 2003 Feb. 50(1):105-24. [Medline].

  83. Baylin EB, Gladstone GJ. Endoscopic lacrimal surgery. Otolaryngol Clin North Am. 2005 Oct. 38(5):1099-107. [Medline].

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Periorbital cellulitis. This image shows an 8-year-old patient who presented with unilateral eyelid swelling and erythema.
Acute dacryocystitis.
Upper eyelid anatomy.
Lower eyelid anatomy.
Eye and lacrimal duct, anterior view.
 
 
 
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