Also known as preseptal cellulitis, periorbital cellulitis is an infection localized in the periorbital area and on the eyelid. It manifests by acute edema and erythema around theese soft tissues. The main causes are the local spread of infection from the respiratory tract or from ocular infections. Another cause of periorbital cellulitis is after an eyelid trauma.
Periorbital cellulitis pathology
In order to determine the severity of the periorbital cellulitis it is important to locate it. The most important anatomical landmark is the orbital septum, which separates the eyelid from the orbital structures located deeper. It actually actions like a barrier in preventing the spreading of the infection from the eyelid into the orbital cavity. If the periorbital cellulitis extends into the orbit, behind the septum, it can cause orbital cellulitis, provoking even meningitis or cavernous sinus thrombosis.
Periorbital cellulitis causes
The infections of the upper respiratory tract are commonly a cause of preseptal cellulitis, especially when talking about paranasal sinusitis. The micro-organisms causing upper respiratory tract infections are Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus species, and anaerobes. The next step of the infection is the eyelid infection.
Before the invention of the vaccine against Haemophilus influenzae type B, one of the most frequent causes of periorbital cellulitis in children was Haemophilus influentzae type B. Nowadays, not even one bacterium is still associated with this disease in children. Other causes of the periorbital cellulitis are linked with trauma the eye might have suffered. Bug bites or recent surgical procedures near the eyelids, hordeola, chalaxia or oral procedures can lead to infections in the eyelid. Also systemic diseases might cause periorbital cellulitis.Varicella, Neutropenia, Asthma or Nasal polyposis are usually linked to this disease.
Periorbital cellulitis was also reported to appear in anthrax and smallpox.
Periorbital cellulitis pictures
Periorbital cellulitis symptoms
Patients usually present a moderate elevation of the body temperature. They may also complain about epiphora, pain in the eyelid area, blurred vision or conjunctivitis. It is also easy to observe the periorbital edema and erythema. There are cases when the patient cannot even open the affected eye.
There are no predilections related to racial or sexual criteria. Regarding the age, periorbital cellulitis is in the first place a pediatric ailment. Studies have revealed that almost 80% of patients suffering from preseptal cellulitis are youger than 10 years old . Moreover, most patients are actually younger than 5 years. On the other hand, patients with orbital cellulitis tend to be older than the first category.
Morbidity is associated with periorbital cellulitis only if it spreads to the orbit. In this case, if it is not treated promptly, orbital abscess or cavernous sinus thrombosis can appear. This may seriously threaten one's vision and finally end up in sepsis or even meningitis.
Blood tests, ocular examination and medical history are equally important in establishing the diagnosis of periorbital cellulitis. The doctor will perform certain tests, checking your vision and pupillary reactions or the resistance to specific moves. Also the lymphadenopathy can be a sign for conjunctivitis, so the doctor will also look for lymph nodes. In order to check the optic nerve, an ocular fundus will be done. In case of upper respiratory tract infections, a consult in this area might be recommended.
Periorbital cellulitis treatment
The main goal in treating periorbital cellulitis is to avoid the spread into the orbital area, thing that can be dramatic for the eye. In adults, the most common treatment is the administration of oral antibiotics, while in young children the best results are obtained with IV antibiotics. In severe cases, IV antibiotics will be prescribed to adults as well.