Postseptal Cellulitis

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  • Inflammation of the subcutaneous tissue behind (+/- anterior) the orbital septum.
  • Postseptal cellulitis = orbital cellulitis


  • Usually progression of periorbital infections e.g. from sinuses (ethmoid sinus in 90%), skin (skin lesions, insect bites, hordeolum) and lacrimal sac
  • Haematogenous in bacteraemia
  • Exogenous through foreign bodies (trauma, surgery)


  • Periorbital redness, swelling, hyperaemia
  • Restricted bulbar motility, pain with eye movement, RAPD, anisocoria, exophthalmos, IOP rise, vision loss, conjunctival chemosis
    • signs of postseptal involvement


  • Differential blood count, CRP, ESR, Creatinine
  • High-resolution CT head/orbita (abscess? sinusitis? sinus cavernosus thrombosis?), consider MRI
  • Involve ENT or oral and maxillofacial surgeon if necessary (in case of sinusitis or abscess)

Differential Diagnoses


  • Co-amoxicillin (amoxicillin+clavulanic acid) 1.2g i.v. 3x/d, oral after 2-3 days if response is good (total 10-14 days).
    • Alternative: Cephalosporins (cefazolin, ceftazidime, cefuroxime or ceftriaxone i.v., depending on internal hospital guidelines) or clindamycin 3x 600mg i.v. (Cave: incomplete coverage).
    • Cave in immunosuppressed patients: consult infectiology, signs of mucormycosis?
  • Consider additional local antibiotics for dacryocystitis (e.g. Tobrex gtt (Tobramycin) 4x daily).
  • Consider decongestant nasal spray, e.g. Otrivin (Xylometazolin) for sinusitis
  • In case of injuries: tetanus booster shot


  • EyeWiki Orbital Cellulitis
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)