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Periorbital Cellulitis - Causes, Symptoms and Treatment

 

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Periorbital cellulitis is an inflammation and infection of the eyelid of the soft tissues around the eye. There are actually two different kinds of periorbital cellulitis, depending on exactly where the infected soft tissues are. Preseptal cellulitis involves the eyelids and the soft tissues around the eyes, but not the eyeball or anything else in the orbit. Preseptal cellulitis usually begins superficial to the orbital septum; orbital cellulitis usually begins deep to the orbital septum. Preseptal cellulitis is caused by contiguous spread of infection from local facial or eyelid trauma, insect bites, conjunctivitis, or chalazion. It can be the result of minor trauma to the area around the eye, or it may be the extension of another site of infection, such as sinusitis. Periorbital cellulitis is most common in children under six years of age. Patients with periorbital cellulitis do not have bulging of the eye, limited eye movement, 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. Surgery to decompress the orbit and open infected sinuses is indicated if vision is compromised, suppuration or foreign body is suspected.

Causes of Periorbital cellulitis

Orbital and periorbital cellulitis are usually caused by infection of the sinuses near the nose. It can be the result of minor trauma to the area around the eye, or it may be the extension of another site of infection, such as sinusitis. Insect bites or injuries that break the skin cause about one-third of these cellulitis infections. Orbital and periorbital cellulitis may also occur in people with a history of dental infections. The most common bacteria that cause periorbital cellulitis in adults are streptococcus and staphylococcus.

Common causes and risk factors of Periorbital cellulitis:

  • Insect bites or injuries.
  • Direct infection accompanying local trauma.
  • A history of dental infections.
  • Dacryocystitis.
  • Chalazion, hordeolum.

Signs and Symptoms of Periorbital cellulitis

There is generally redness and swelling of the eyelid and the surrounding area, but unlike orbital cellulitis, periorbital cellulitis does not cause protrusion of the eyeball or limit its movements. Signs of the primary infection are also often present (eg, nasal discharge and bleeding with sinusitis, periodontal pain and swelling with abscess). Fever, malaise, and headache should raise suspicion of associated meningitis. Some or all of these findings may be absent early in the course of the infection.

Sign and symptoms may include the following :

  • Diminished ability to see clearly.
  • Pain with eye movements.
  • Fever, malaise, and headache.
  • Eye pain.
  • Swelling and redness of the eyelid.

Treatment for Periorbital cellulitis

The goal of treatment for periorbital cellulitis is to treat the affected area and to prevent periorbital cellulitis from becoming orbital cellulitis, which is a medical emergency. Antibiotics are used to stop the spread of infection and prevent damage to the optic nerve, which transmits visual images to the brain. Patients with orbital cellulitis should be hospitalized and treated with meningitis-dose antibiotics. Oral antibiotics are used to treat periorbital cellulitis in adults; IV antibiotics are used to treat the infection in young children.

Treatment may include:

  • Paracetamol for pain relief and fever control.
  • Antibiotics are used to stop the spread of infection and prevent damage to the optic nerve, which transmits visual images to the brain.
  • Heat packs over areas may be used.
  • Oral antibiotics are used to treat periorbital cellulitis in adults; IV antibiotics are used to treat the infection in young children. However, adults with severe symptoms may receive IV antibiotics as well.
  • Posaconazole now available as alternate regimen for treatment of zygomycetes.