Tenderness, redness, warmth, and swelling of the eyelid and periorbital area. Often there is a history of local skin abrasions, penetrating injury/trauma, hordeolum, or insect bites. Can be associated with sinusitis, although this is more common with postseptal infections. May complain of fever or chills.
(See Figures 6.10.1 and 6.10.2.)
Critical
Eyelid erythema, tense edema, warmth, and tenderness. No proptosis, no optic neuropathy, no extraocular motility restriction, usually little to no conjunctival injection, and no pain with eye movement (unlike orbital cellulitis). The patient may not be able to open the eye because of eyelid edema. Visual changes such as blurred vision or monocular diplopia attributed to swollen eyelids.
Other
Tightness of eyelid skin or fluctuant eyelid edema. The eye itself may be slightly injected but is relatively uninvolved.
Organisms
S. aureus and Streptococcus are most common, but H. influenzae should be considered in nonimmunized children. Suspect anaerobes if foul-smelling discharge or necrosis is present or if there is a history of an animal or human bite. Consider a viral cause if preseptal cellulitis is associated with a vesicular skin rash (e.g., herpes simplex or varicella zoster).
NOTE: |
Patients with the following risk factors should be covered for MRSA: history of MRSA infection or colonization, recurrent skin infections, contact with someone known to have MRSA, admission to a healthcare or long-term care facility within the past year, placement of a permanent indwelling catheter, on hemodialysis, i.v. drug use, incarceration within the past 12 months, participation in sports that include skin-to-skin contact or sharing of equipment and clothing, and poor personal hygiene. |
NOTE: |
Oral antibiotics are maintained for 10 to 14 days. |
NOTE: |
Intravenous antibiotics can be changed to comparable oral antibiotics after significant improvement is observed. Systemic antibiotics are maintained for a complete 10- to 14-day course. See 7.3.1, ORBITAL CELLULITIS, for alternative treatment. In complicated cases or patients with multiple allergies, consider consultation with an infectious disease specialist for antibiotic management. |
Daily until clear and consistent improvement is demonstrated, then every 2 to 7 days until the condition has totally resolved. If preseptal cellulitis progresses despite antibiotic therapy, the patient is admitted to the hospital and a repeat (or initial) orbital CT scan is obtained. For patients already on p.o. antibiotics, switch to i.v. antibiotics (see 7.3.1, ORBITAL CELLULITIS).