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- An acute, spreading infection of the skin and SC tissue of the area anterior to the orbital septum but the inflammation does not extend into the bony orbit
- Synonym(s): Preseptal cellulitis
It is important to distinguish periorbital cellulitis from orbital cellulitis (posterior to the orbital septum; symptoms include restricted extraocular mobility, diplopia, proptosis, and globe displacement vision loss), which is a potentially life-threatening condition.
- Occurs more commonly in children, with mean age 21 months.
- 3 times more common than orbital cellulitis (1)
Increased incidence in the winter months (due to increased number of cases of sinusitis) (1)
- Contiguous spread from upper respiratory infection
- Local skin trauma
- Insect bite
- Puncture wound
No known genetic predisposition
- Avoid dermatologic trauma.
- Avoid swimming in fresh or salt water with skin abrasion.
- Thanks to routine vaccination, the incidences of Haemophilus influenzaeB and Streptococcus pneumoniae as potential etiologies for periorbital cellulitis have decreased.
- An understanding of the anatomy of the eyelid is important in distinguishing preseptal from orbital cellulitis:
- The orbital septum is a sheet of connective tissue that extends from the orbital bones to the margins of the upper and lower eyelids, and it acts as a barrier to infection deep in the orbital structures.
- Infection of the tissues superficial to the orbital septum is called periorbital (aka preseptal) cellulitis, whereas infection deep in the orbital septum is termed orbital (aka postseptal) cellulitis.
- Periorbital cellulitis classically arises from a contiguous infection of soft tissues of the face, secondary to:
- Sinusitis (via lamina papyracea) extension
- Local trauma
- Insect or animal bites
- Foreign bodies
- Dental abscess extension
- Hematogenous seeding
- Common organisms: (1)
- Staphylococcus aureus, typically MSSA (although increasing incidence of MRSA)
- Staphylococcus epidermidis
- Streptococcus pyogenes
- Atypical organisms:
- Acinetobacter sp.
- Nocardia brasiliensis
- Bacillus anthracis
- Pseudomonas aeruginosa
- Neisseria gonorrhoeae
- Proteus sp.
- Pasteurella multocida
- Mycobacterium tuberculosis
- Trichophyton sp. (ringworm)
- Since the introduction of the Hib vaccine, the incidence of H. influenzae has decreased; however, this organism should be suspected in the unimmunized or partially immunized.