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