Periorbital Cellulitis

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

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Basics

Description

  • Periorbital or preseptal cellulitis is an acute infection characterized by pain, erythema, and edema to the anterior eyelid and surrounding tissue.
  • The infection lies superficial to the orbital septum, a thin fascial layer forming the anterior boundary of the orbital compartment.
  • In contrast, orbital cellulitis (postseptal disease) is a deep space infection involving the deeper structures of the orbit and requires emergent intervention.

Epidemiology

  • Often occurs in young children, commonly <5 years of age but can occur at any age
  • Periorbital cellulitis is at least 3 times more common than orbital cellulitis.

Risk Factors

  • Predisposing factors that may lead to periorbital cellulitis include local skin trauma (e.g., insect bite, scratch, eczema) and lacrimal/eyelid injury.
  • There is a slight increase incidence of orbital cellulitis in winter months.

General Prevention

  • Haemophilus influenzae type b vaccine has decreased the incidence of H. influenzae-associated periorbital cellulitis.
  • Pneumococcal conjugate vaccine may decrease streptococcal disease.

Pathophysiology

  • Often, extension from an external source including trauma (insect bite, recent surgery, foreign body) or adjacent infection (sinusitis, dacryocystitis, hordeola, dental abscess)
  • In contrast, orbital cellulitis is often caused by paranasal sinus disease.

Etiology

Variable depending on mechanism

  • Most common pathogens are from skin flora including
    • Staphylococcus aureus (increasingly methicillin-resistant)
    • Group A Streptococcus
    • Streptococcus pneumoniae
    • Other streptococci species
  • Anaerobic infections can extend from dental source.
  • H. influenzae type b was historically the most common pathogen; consider in unimmunized child <5 years of age.

Commonly Associated Conditions

Rarely associated with bacteremia; however, consider this condition in children <3 years of age or in immunocompromised patients.

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