Preseptal and orbital cellulitis usually progress more rapidly and are more severe in children than in adults. See also BCSC Section 7, Oculofacial Plastic and Orbital Surgery.
Preseptal cellulitis, a common infection in children, is an inflammatory process involving the tissues anterior to the orbital septum. Eyelid edema may extend into the forehead. The periorbital skin becomes taut and inflamed, and edema of the contralateral eyelids may appear. Proptosis is not a feature of preseptal cellulitis, and the globe remains uninvolved. Full ocular motility and absence of pain on eye movement help distinguish preseptal from orbital cellulitis.
Preseptal cellulitis typically develops in 1 of 3 ways:
following puncture, insect bite, or laceration of the eyelid skin (posttraumatic cellulitis): In these cases, organisms found on the skin, such as Staphylococcus or Streptococcus species, are most commonly responsible for the infection.
in conjunction with severe conjunctivitis such as epidemic keratoconjunctivitis or methicillin-resistant Staphylococcus aureus (MRSA) conjunctivitis, or with skin infection such as impetigo or herpes zoster.
secondary to upper respiratory tract or sinus infection: Streptococcus pneumoniae and other streptococcal species, and S aureus are the most common causative organisms.
Children with nonsevere preseptal infections can be treated with oral antibiotics as outpatients. Broad-spectrum drugs effective against the most common pathogens, such as cephalosporins or ampicillin–clavulanic acid combination, are usually effective. Particularly with eyelid abscesses, clindamycin may be an appropriate choice because of the increasing prevalence of MRSA, which should also be considered in patients who do not improve with treatment. Eyelid abscesses may require urgent incision and drainage.
For young infants or patients with signs of systemic illness such as sepsis or meningeal involvement, hospital admission may be indicated for appropriate cultures, imaging of the sinuses and orbits, and intravenous (IV) antibiotics. In newborns, dacryocystocele should be considered in the differential diagnosis (see Chapter 19).
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.