Periorbital cellulitis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Preseptal cellulitis
Overview
Periorbital cellulitis is an inflammation and infection of the eyelid and area around the eye. Periorbital cellulitis is also called preseptal cellulitis because it affects the structures in front of the septum, such as the eyelid and skin around the eye. Periorbital cellulitis often occurs from a scratch or insect bite around the eye that leads to infection of the skin. Symptoms can include swelling, redness, pain, and tenderness to touch occurring around one eye only. The affected person is able to move the eye in all directions without pain, but there can be difficulty opening the eyelid, often due to swelling. Also vision is normal.
Characteristics
Periorbital cellulitis must be differentiated from orbital cellulitis, which is an infection involving the soft tissues posterior to the orbital septum, including the fat and muscle within the bony orbit ant it is an emergency and sight-threatening situation. 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.