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- 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
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.
- Occurs more commonly in children; mean age 21 months
- 3 times more common than orbital cellulitis (1)[C]
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 (1)[C]
- Staphylococcus aureus, typically MSSA (MRSA is increasing.)
- Staphylococcus epidermidis
- Streptococcus pyogenes
- Atypical organisms
- Acinetobacter sp.; Nocardia brasiliensis
- Bacillus anthracis; Pseudomonas aeruginosa
- Neisseria gonorrhoeae; Proteus sp.
- Pasteurella multocida; Mycobacterium tuberculosis; Trichophyton sp. (ringworm)
- Since vaccine introduction, the incidence of Haemophilus influenzae disease has decrease (should still be suspected in unimmunized or partially immunized patients).
No known genetic predisposition
- Contiguous spread from upper respiratory infection
- Acute sinusitis
- Dental infection
- Local skin trauma/puncture wound
- Insect bite
- 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