Introduction
Epidemiology
- Incidence: 10.00 cases per 100,000 person-years
- Peak incidence: 6-15 years
- Sex ratio: 1:1
Condition | Relative incidence |
---|---|
Preseptal cellulitis | 1 |
Orbital cellulitis | 0.10 |
<1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Pathophysiology
Clinical features
- The patient presents with a red, swollen, painful eye of acute onset. They are likely to have symptoms associated with fever.
Signs
- Erythema and oedema of the eyelids, which can spread onto the surrounding skin
- Partial or complete ptosis of the eye due to swelling
- Orbital signs (pain on movement of the eye, restriction of eye movements, proptosis, visual disturbance, chemosis, RAPD) must be absent in preseptal cellulitis - their presence would indicate orbital cellulitis
Investigations
- Bloods - raised inflammatory markers
- Swab of any discharge present
- Contrast CT of the orbit may help to differentiate between preseptal and orbital cellulitis. It should be performed in all patients suspected to have orbital cellulitis
Differential diagnosis
- Orbital cellulitis
- Allergic reaction
Management
- All cases should be referred to secondary care for assessment
- Oral antibiotics are frequently sufficient - usually co-amoxiclav
- Children may require admission for observation
Complications
- Bacterial infection may spread into the orbit and evolve into orbital cellulitis