Preseptal Cellulitis Clinical Presentation

Updated: Mar 10, 2021
  • Author: Mounir Bashour, MD, PhD, CM, FRCSC, FACS; Chief Editor: Edsel B Ing, MD, PhD, MBA, MEd, MPH, MA, FRCSC  more...
  • Print


Patients may have mild to moderate temperature elevation. Although it has been suggested that orbital cellulitis generates a greater leukocytosis and febrile response than preseptal cellulitis does, it is widely believed that these responses cannot be used to differentiate the 2 conditions from each other.

Patients may complain of the following:

  • Pain

  • Conjunctivitis

  • Epiphora

  • Blurred vision

Signs of preseptal cellulitis include periorbital erythema and edema (sometimes so severe that patients cannot voluntarily open the eye).

Following periorbital trauma, foreign body should be excluded.

In febrile patients with pain disproportionate to clinical findings, periorbital necrotizing fasciitis should be considered.


Physical Examination

Because orbital cellulitis and preseptal cellulitis can each present with eyelid inflammation, it is important to perform a complete ocular examination. Be alert for signs of systemic illness, especially in children.

The eyelids and ocular adnexa should be inspected for signs of local trauma. Cervical, submandibular, or preauricular lymphadenopathy may be present. A tender preauricular lymph node may be suggestive of adenoviral conjunctivitis. Conjunctivitis may be present, and the quality of conjunctival drainage should be noted.

Test vision and pupillary reactions in all patients who present with eyelid inflammation. Limited motility, impaired vision, and/or relative afferent pupillary defects suggest that the inflammation has spread beyond the septum. A relative afferent pupillary defect indicates optic nerve compression, and immediate surgical drainage should be performed.

Resistance to retropulsion and proptosis also suggest orbital involvement. A Desmarres retractor or eyelid speculum may be needed to examine the eye and ocular movements.

The ocular fundus should be examined carefully for signs of optic nerve swelling and venous engorgement.

Inspect for possible dacryocystitis [9] or dacryoadenitis, which can result in the spread of inflammation to adjacent tissues.

Sinus tenderness, rhinorrhea, adenopathy, and other hallmarks of upper respiratory tract infection may be present. [9]