Post on 13-Sep-2014
Preseptal Cellulitis
Prepared by: Junior Intern Charles Nicole P. Alonzo
Cellulitis
• is a skin infection (inflammation) characterized with redness., swelling, pain and warmth.
Preseptal type (or Periorbital)• also known as eyelid cellulitis, is a medical
condition that occurs around the eyelid
Preseptal cellulitis
• is a periocular superficial cellulitis that has not breached the orbital septum
Periorbital Cellulitis
Findings: Inflammation and swelling of soft tissues anterior to, but not posterior to the orbital septum, consistent with periorbital cellulitis.
Pathophysiology
• This may also arise in one of three situations:– As a result of local skin trauma such as lacerations
and insect bites– Due to spread from local infection such as
dacrocystitis, hordeolum and paranasal sinuses– Spread from distant infections such as those
outlined above as well as from the upper respiratory tract.
The most common pathogenic organisms are
– S. aureus, – S. epidermidis, – streptococci – anaerobes
• MRSA has also been isolated in cases but again, this currently remains very rare
Symptoms
• Unilateral
• Tenderness, erythema and swelling of lids and periorbital area
• May be a mild fever
• Often recent history of sinusitis/local skin abrasions or bites
Signs
• Erythema with tense edema: may not be able to open lid
• Tenderness
• Normal or just slightly blurred visual acuity
Signs
• Absence of– Proptosis
– Restriction in ocular motility
– Pain on eye movement
– Evidence of optic neuropathy
Differential Diagnosis Orbital/Preseptal Cellulitis
• Necrotising fasciitis• Chalazion• Allergic lid swelling• Severe viral conjunctivitis• Cavernous sinus thrombosis• Erysipelas• Other orbital conditions e.g. thyroid eye disease, orbital
tumours/pseudotumours, orbital vasculitis• Other conditions e.g. insect bite, angioedema,
maxillary osteomyelitis
Staging
• Orbital infections fall into one of five categories:
• Stage I - preseptal cellulitis• Stage II - orbital cellulitis• Stage III - subperiosteal abscess (which may arise from
orbital cellulitis or paranasal sinusitis)• Stage IV - orbital abscess (a complication of orbital
cellulitis)• Stage V - cavernous sinus thrombosis and infection (the
cavernous sinus drains venous blood from both eyes)
Management
• Adults: 250(qds) - 500(tds)mg oral co-amoxiclav depending on severity of infection, for 10 days with daily review until there is definite improvement (then every 2-7 days until complete recovery).
• Children: 20-40mg/kg/day oral co-amoxiclav over 24h in three divided doses.
• Lid abscesses should be drained.
• Hospital management may involve intravenous therapy (1-2gm iv ceftriaxone daily until response is seen)
Complications
• Progression to stage II and beyond of orbital infections.
• Unusually, lagophthalmos, lid abscess, cicatricial ectropion and lid necrosis may also be seen in these patients.
Prognosis
• Prompt diagnosis and treatment should result in an uncomplicated course and full recovery
Prevention
• Prophylactic antibiotics are prudent in the management of surgical and accidental trauma to the lid.
• Chloramphenicol ointment is a good first choice, applied qds to the clean wound for a week.
• Traumatic lid laceration also benefits from a review a 48-72h down the line to help identify any emerging preseptal cellulitis early.
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