Preseptal Cellulitis

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Definition

  • Inflammation of the subcutaneous tissue anterior to the orbital septum

Aetiology

  • Trauma/periorbital skin lesion, insect bite, hordeolum/chalazion, dacryocystitis, spread from sinusitis, rarely associated with varicella, asthma, nasal polyps, neutropenia

Findings

  • Pronounced periocular swelling, conjunctivitis
  • No signs of (contrary to Postseptal Cellulitis):
    • Restricted eye movements, pain with eye movement, RAPD, anisocoria, exophthalmos, IOP rise, vision loss, conjunctival chemosis

Work-up

  • Consider full blood count, CRP, ESR, creatinine
  • CT / MRI orbit if Postseptal Cellulitis is suspected

Management

  • adults and older children: Co-Amoxicillin (amoxicillin+clavulanic acid) 3x1g/d for 7-10 days; in penicillin allergy clindamycin (Dalacin C) 300-450mg 3x daily, reserve in adults: moxifloxacin 400 mg once daily (off-label)
  • Children >1 year: amoxicillin+clavulanic acid 25-50 mg/kg/day (amoxicillin/clavulanic acid 4:1) orally in 3 doses
  • Children <1 year: Zinacef (cefuroxime) 50mg/kg i.v. 3x daily, as an inpatient
  • Abscess: surgical drainage and i.v. antibiotics
  • Injuries: tetanus booster if needed

Follow-up

  • after 1-2 days
  • Admit for IV antibiotics if: child under 1 year, systemically unwell/fever, no improvement after 24–48 h of oral treatment, signs of orbital cellulitis, poor compliance

Differential Diagnosis

  • Postseptal Cellulitis, necrotising fasciitis (subcutaneous emphysema?), conjunctivitis, dacryoadenitis, contact dermatitis

Sources

  • EyeWiki Preseptal Cellulitis
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Kalla A. Gervasio MD, Travis J. Peck MD et al.; Wolters Kluwer; 8th edition (2021)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; John F. Salmon; Elsevier; 10th edition (2024)
  • SwissPedDose