- 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.
There's more to see -- the rest of this topic is available only to subscribers.
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 MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617226/all/Periorbital_Cellulitis. Accessed June 9, 2023.
Periorbital Cellulitis. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617226/all/Periorbital_Cellulitis
Periorbital Cellulitis [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2023 June 09]. 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 -