Preseptal Cellulitis

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  • Inflammation of the subcutaneous tissue anterior to the orbital septum


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


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


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


  • in adults and older children: Co-Amoxicillin (amoxicillin+clavulanic acid) 3x1g/d for 10-14 days; in case of penicillin allergy, alternatively Dalacin (clindamycin) 300mg 2-3x daily or Bactrim forte (Sulfamethoxazol+Trimethoprim) 1-0-1 or Moxifloxacin 400mg 1-0-1
  • children <1 year: Zinacef (Cefuroxim) 50mg/kg i.v. 3x daily
  • in case of abscess: surgical drainage and i.v. antibiotics
  • in case of injuries: tetanus booster shot


  • after 1-2 days

Differential Diagnosis

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


  • EyeWiki Preseptal 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)