Cellulitis, Periorbital
Basics
Description
- An acute bacterial infection of the skin and subcutaneous tissue anterior to the orbital septum; does not involve the orbital structures (globe, fat, and ocular muscles)
- Synonym(s): preseptal cellulitis
ALERT
It is essential to distinguish periorbital cellulitis from orbital cellulitis. Orbital cellulitis is a potentially life-threatening condition. Orbital cellulitis is posterior to the orbital septum; symptoms include restricted eye movement, pain with eye movement, proptosis, and vision changes.
It is essential to distinguish periorbital cellulitis from orbital cellulitis. Orbital cellulitis is a potentially life-threatening condition. Orbital cellulitis is posterior to the orbital septum; symptoms include restricted eye movement, pain with eye movement, proptosis, and vision changes.
Epidemiology
- Occurs more commonly in children; mean age 21 months
- 3 times more common than orbital cellulitis
Incidence
Increased incidence in the winter months (due to increased cases of sinusitis)
Etiology and Pathophysiology
- The anatomy of the eyelid distinguishes periorbital (preseptal) from orbital cellulitis:
- A connective tissue sheet (orbital septum) extends from the orbital bones to the margins of the upper and lower eyelids; it acts as a barrier to infection of deeper orbital structures.
- Infection of tissues anterior to the orbital septum is periorbital (preseptal) cellulitis.
- Infection deep to the orbital septum is orbital (postseptal) cellulitis.
- Periorbital cellulitis typically arises from a contiguous infection of soft tissues of the face.
- Sinusitis (via lamina papyracea) extension
- Local trauma; insect or animal bites
- Foreign bodies
- Dental abscess extension
- Hematogenous seeding
- Common organisms
- Staphylococcus aureus, typically MSSA (MRSA is increasing.)
- Staphylococcus epidermidis
- Streptococcus pyogenes
- Atypical organisms
- Acinetobacter spp.; Nocardia brasiliensis
- Bacillus anthracis; Pseudomonas aeruginosa
- Neisseria gonorrhoeae; Proteus spp.
- Pasteurella multocida; Mycobacterium tuberculosis; Trichophyton sp. (ringworm)
- Since vaccine introduction, the incidence of Haemophilus influenzae disease has decreased (should still be suspected in unimmunized or partially immunized patients).
Genetics
No known genetic predisposition
Risk Factors
- Contiguous spread from upper respiratory infection
- Acute sinusitis
- Conjunctivitis
- Blepharitis
- Dental infection
- Local skin trauma/puncture wound
- Insect bite
- Bacteremia
General Prevention
- Avoid trauma around the eyes.
- Avoid swimming in fresh or salt water with facial skin abrasions.
- Routine vaccination: particularly H. influenzae type B and Streptococcus pneumoniae
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Citation
Domino, Frank J., et al., editors. "Cellulitis, Periorbital." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116943/1.1/Cellulitis_Periorbital.
Cellulitis, Periorbital. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116943/1.1/Cellulitis_Periorbital. Accessed November 8, 2024.
Cellulitis, Periorbital. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116943/1.1/Cellulitis_Periorbital
Cellulitis, Periorbital [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 November 08]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116943/1.1/Cellulitis_Periorbital.
* Article titles in AMA citation format should be in sentence-case
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ED - Baldor,Robert A,
ED - Golding,Jeremy,
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BT - 5-Minute Clinical Consult, Updating
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