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Periorbital Cellulitis

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

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  • 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.

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.


  • 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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Cabana, Michael D., editor. "Periorbital Cellulitis." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617226/all/Periorbital_Cellulitis.
Periorbital Cellulitis. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617226/all/Periorbital_Cellulitis. Accessed June 24, 2019.
Periorbital Cellulitis. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617226/all/Periorbital_Cellulitis
Periorbital Cellulitis [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 June 24]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617226/all/Periorbital_Cellulitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Periorbital Cellulitis ID - 617226 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617226/all/Periorbital_Cellulitis PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -