Periorbital cellulitis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Preseptal cellulitis
Overview
Periorbital cellulitis, also known as preseptal cellulitis, is an inflammation and infection of the eyelid and portions of skin around the eye. It may be caused by breaks in the skin around the eye, and subsequent spread to the eyelid; infection of the sinuses around the nose (sinusitis); or from spread of an infection elsewhere through the blood.
Characteristics
Periorbital cellulitis must be differentiated from orbital cellulitis, which is an emergency and requires intravenous (IV) antibiotics. In contrast to orbital cellulitis, patients with periorbital cellulitis do not have bulging of the eye (proptosis), limited eye movement (ophthalmoplegia), pain on eye movement, and loss of vision. If any of these features is present, one must assume that the patient has orbital cellulitis and begin treatment with IV antibiotics. CT scan may be done to delineate the extension of the infection.
Causes
Staphylococcus and streptococcus species are commonly implicated. The advent of the Haemophilus influenzae vaccine has dramatically decreased the incidence of periorbital and orbital cellulitis.
Treatment
Antimicrobial Regimens
- Periocular infection[1]
- 1. Causative pathogens
- Streptococcus spp.
- Methicillin-sensitive Staphylococcus aureus (MSSA)
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Hemophilus influenzae
- 2. Empiric antimicrobial therapy
- Preferred regimen (1): Clindamycin 300-450 mg PO q6h for 1-2 weeks OR Clindamycin 600-900 mg IV q8h for 1-2 weeks
- Preferred regimen (2): Daptomycin 4 mg/kg IV qd for 1-2 weeks
- Alternative regimen (1): Trimethoprim/Sulfamethoxazole 160 mg PO q12h for 1-2 weeks OR Trimethoprim/Sulfamethoxazole 2.5 mgkg IV q12h for 1-2 weeks
- Alternative regimen (2): Doxycycline 100 mg IV or PO q12h for 1-2 weeks
- Alternative regimen (3): Linezolid 600 mg IV or PO q12h for 1-2 weeks
- Alternative regimen (4): Vancomycin 1 g IV q12h for 1-2 weeks
- 3. Pathogen-directed antimicrobial therapy
- 3.1 Methicillin-resistant Staphylococcus aureus
- Preferred regimen (1): Vancomycin 1 g IV q12h for 1-2 weeks
- 3.2 Non-MRSA organisms
- Preferred regimen (1): Clindamycin 300-450 mg PO q6h for 1-2 weeks OR Clindamycin 600-900 mg IV q8h for 1-2 weeks
- Preferred regimen (2): Daptomycin 4 mg/kg IV qd for 1-2 weeks
- Alternative regimen (1): Trimethoprim/Sulfamethoxazole 160 mg PO q12h for 1-2 weeks OR Trimethoprim/Sulfamethoxazole 2.5 mgkg IV q12h for 1-2 weeks
- Alternative regimen (2): Doxycycline 100 mg IV or PO q12h for 1-2 weeks
- Alternative regimen (3): Linezolid 600 mg IV or PO q12h for 1-2 weeks
See also
References
- ↑ Bilyk JR (2007). "Periocular infection". Curr Opin Ophthalmol. 18 (5): 414–23. doi:10.1097/ICU.0b013e3282dd979f. PMID 17700236.
Donahue S, Schwartz G (1998). "Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum". Ophthalmology. 105 (10): 1902–5, discussion 1905-6. PMID 9787362.