What is Periorbital (Preseptal) Cellulitis: Treatment, Symptoms, Pictures

Cellulitis, most frequently associated with the limbs, normally the legs, can strike in other locales, including the eyes. Cellulitis is a bacterial infection which should not be ignored under any circumstances. Correspondingly, eyes are not to be trifled with so cellulitis in or around the eyes needs instantaneous assessment and remedy.

What is Periorbital or Preseptal Cellulitis?

In simple terms, infection of the eyelid and the adjacent skin sitting in front of the orbital septum is designated Periorbital or Preseptal Cellulitis. Infection may derive from a primary origin in the eyelids so a scratch, nasty stye, insect bite or conjunctivitis.

Further, causes may originate from elsewhere, for example, spreading from teeth or nasal passages.

What is the Orbital Septum?

The orbital septum is an ingenious barrier in the human eyelid that resists the entry of infection to the eyes, protecting and defending the orbital tissues. Infection that tracks into the inner orbit of the eye causes serious problems, possibly disrupting sight and functionality. Additionally, it can also affect the sinuses and cranial nerves.

Signs and Symptoms to aid diagnosis

The eye and eyelid will be tender to palpate, there may be localised swelling, some heat and inflammation appearing as red skin and mucous membranes. The enlargement may be sufficient to inhibit the patient from opening their eye partially or completely making examination challenging for the clinician and very uncomfortable for the sufferer. Despite appearances which can be shocking, the eye itself is customarily substantially unaffected with unimpaired vision and ocular locomotion all fully functional. The distension does not usually extend beyond the eyelids which actually end up forming a protective seal over the eye itself.

Periorbital cellulitis in pictures

Prepare to be horrified! These make for some gut-wrenching viewing, it’s hard to assimilate that the people with periorbital cellulitis in these pictures have not suffered a momentous accident or, that they are not enduring a really grave disease. Periorbital cellulitis is not a life and death matter but, never run the risk when it comes to looking after your eyes. Seek professional, qualified advice without delay.

Children contract Periorbital Cellulitis more frequently

Youngsters, pre-schoolers and toddlers habitually contract eye infections, more than adults. Sticky eye, conjunctivitis, these are all maladies which any parent of a young child will be more than familiar with. 99% of cases are a bacterial infection from one of three possible types, Staphylococcus Aureus, Streptococcus Pyogenes and Haemophilus Influenzae. Little ones always have their hands all over their faces, they are also prone to injury as they develop and grow. The contagious infection will be shared at a toddler group or nursery. Or, the infection may develop in the sinus. Most children between the ages of eighteen months and three years old seem to have permanent colds, bugs and snotty noses. It is their emerging immune system coupled with exposure to other infants, a sort of juvenile plague pit! General lack of awareness and cleanliness equal provide a great breeding ground for periorbital cellulitis.

A tough parenting challenge

Diagnosing and managing eye conditions in small children are not to be underestimated. Redness, swelling and pain may arise suddenly and visually, look quite frightening. The eye may bulge, affecting vision – there will be associated pain and discomfort. Unfortunately, toddlers have usually just arrived at that stage of their development when they exhibit fascination and fear in equal measure, especially of their physical integrity and bodily function. The doctor’s surgery looks and smells unfamiliar plus, factor in their highly developed sense of ‘stranger danger’.

The key thing with small children is a friendly and calm manner. Allow the child to sit on the lap of the parent or carer throughout the examination. The doctor should explain carefully in language the child can follow, exactly what is going to happen. A relaxed demeanour is crucial as children feed off adult emotions. Paediatricians usually have well-honed skills and modern and up-to-date paediatric units are designed and decorated very much with children in mind and don’t look like conventional hospitals.

What will be the prescribed treatment for your child’s periorbital cellulitis?

Under current guidelines, children aged over 12 months and with only a mild presentation of the illness, may be treated with oral antibiotics – hurrah, no eye drops! It is recommended however that the eyes are gently cleaned with warm water and cotton pads to remove gunge and dry crusty matter which can irritate and encourage rubbing.

Those aged less than one year or manifesting with a more severe infection will require hospital admission. This is to avoid complications and the potential development of orbital cellulitis, a far more worrying condition. The treatment plan for periorbital cellulitis in adults is not dissimilar but they do make far more reasonable patients!

How common is periorbital cellulitis in adults?

Adults can succumb to periorbital cellulitis but are far less prevalent in adults than in children. It is easy to mistake it for something else utterly trivial. Always consult an optician or ophthalmic doctor if you think you are developing an infection in your eyes. Left untreated, the consequences can be dire.



Article References:

  1. https://www.msdmanuals.com/en-gb/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis
  2. https://www.sciencedirect.com/topics/medicine-and-dentistry/orbital-septum
  3. http://www.childrenshospital.org/conditions-and-treatments/conditions/o/orbital-cellulitis/symptoms-and-causes
  4. https://psychcentral.com/lib/if-your-child-is-afraid-of-the-doctor/
  5. https://what0-18.nhs.uk/professionals/hospital-staff/safety-netting-documents-parents/periorbital-cellulitis
  6. https://alderhey.nhs.uk/application/files/8315/0211/2945/Care_of_a_child_with_orbital_cellulitis.pdf