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Cellulitis, Periorbital

Cellulitis, Periorbital is a topic covered in the 5-Minute Clinical Consult.

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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.

Epidemiology

  • Occurs more commonly in children; mean age 21 months
  • 3 times more common than orbital cellulitis (1)[C]

Incidence
Increased incidence in the winter months (due to increased cases of sinusitis) (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).

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 dermatologic 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

Stephens, Mark B., et al., editors. "Cellulitis, Periorbital." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116943/all/Cellulitis__Periorbital.
Cellulitis, Periorbital. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116943/all/Cellulitis__Periorbital. Accessed April 21, 2019.
Cellulitis, Periorbital. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116943/all/Cellulitis__Periorbital
Cellulitis, Periorbital [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116943/all/Cellulitis__Periorbital.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Cellulitis, Periorbital ID - 116943 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116943/all/Cellulitis__Periorbital PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -