Periorbital cellulitis

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Periorbital cellulitis
Other namesPreseptal cellulitis
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Periorbital cellulitis caused by a dental infection (also causing maxillary sinusitis)
Specialty Ophthalmology   OOjs UI icon edit-ltr-progressive.svg

Periorbital cellulitis, or preseptal cellulitis (not to be confused with orbital cellulitis, which is posterior to the orbital septum), is an inflammation and infection of the eyelid and portions of skin around the eye anterior to the orbital septum. [1] It may be caused by breaks in the skin around the eye, and subsequent spread to the eyelid; infection of the sinuses around the nose (sinusitis); or from spread of an infection elsewhere through the blood.

Contents

Signs and symptoms

Periorbital cellulitis must be differentiated from orbital cellulitis, which is an emergency and requires intravenous (IV) antibiotics. 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, or 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.

Affected individuals may experience: swelling, redness, discharge, pain, shut eye, conjunctival infection, fever (mild), slightly blurred vision, teary eyes, and some reduction in vision.

Typical signs include periorbital erythema, induration, tenderness and warmth. [2]

Causes

Staphylococcus aureus , Streptococcus pneumoniae , other streptococci, and anaerobes are the most common causes, depending on the origin of the infection. [3]

The advent of the Haemophilus influenzae vaccine has dramatically decreased the incidence. [4]

Diagnosis

Tests include blood work (CBC) to rule out infectious cause. Also perform a CT scan, x ray of the anterior skull to view the sinuses, MRI scan and finally a soft tissue ultrasound of the orbital region.

Treatment

Antibiotics are aimed at gram positive bacteria. Medical attention should be sought if symptoms persist beyond 2–3 days.

There is inadequate evidence to draw conclusions about the adjunctive corticosteroid therapy in the treatment of periorbital cellulitis. More research is needed to inform decision making. [5]

See also

Related Research Articles

Optic neuritis describes any condition that causes inflammation of the optic nerve; it may be associated with demyelinating diseases, or infectious or inflammatory processes. It is also known as optic papillitis, neuroretinitis and retrobulbar neuritis. It is most often associated with multiple sclerosis, and it may lead to complete or partial loss of vision in one or both eyes. Other causes include:

  1. Hereditary optic neuritis
  2. Parainfectious optic neuritis
  3. Infectious optic neuritis (sinus related or associated with cat scratch fever, tuberculosis, lyme disease and cryptococcal meningitis in AIDS patients
  4. Autoimmune causes
  5. Diabetes Mellitus
  6. Low phosphorus levels
  7. Hyperkalaemia
Sinusitis Inflammation of the mucous membrane that lines the sinuses resulting in symptoms

Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, and cough. It is defined as acute sinusitis if it lasts less than 4 weeks, and as chronic sinusitis if it lasts for more than 12 weeks.

Conjunctivitis Inflammation of the eye

Conjunctivitis, also known as pink eye, is inflammation of the outermost layer of the white part of the eye and the inner surface of the eyelid. It makes the eye appear pink or reddish. Pain, burning, scratchiness, or itchiness may occur. The affected eye may have increased tears or be "stuck shut" in the morning. Swelling of the white part of the eye may also occur. Itching is more common in cases due to allergies. Conjunctivitis can affect one or both eyes.

Cellulitis Bacterial infection of the skin

Cellulitis is a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The borders of the area of redness are generally not sharp and the skin may be swollen. While the redness often turns white when pressure is applied, this is not always the case. The area of infection is usually painful. Lymphatic vessels may occasionally be involved, and the person may have a fever and feel tired.

Blepharitis Medical condition of the eyelid

Blepharitis is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause swelling, burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis by itself is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The primary cause is bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.

Chalazion Medical condition

A chalazion or meibomian cyst is a cyst in the eyelid usually due to a blocked meibomian gland, typically in the middle of the eyelid, red, and not painful. They tend to come on gradually over a few weeks.

Stye Medical condition

A stye, also known as a hordeolum, is a bacterial infection of an oil gland in the eyelid. This results in a red tender bump at the edge of the eyelid. The outside or the inside of the eyelid can be affected.

Cavernous sinus thrombosis Medical condition

Cavernous sinus thrombosis (CST) is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. This is a rare disorder and can be of two types–septic cavernous thrombosis and aseptic cavernous thrombosis. Most commonly the form is of septic cavernous sinus thrombosis. The cause is usually from a spreading infection in the nose, sinuses, ears, or teeth. Staphylococcus aureus and Streptococcus are often the associated bacteria.

Orbital septum

In anatomy, the orbital septum is a membranous sheet that acts as the anterior (frontal) boundary of the orbit. It extends from the orbital rims to the eyelids. It forms the fibrous portion of the eyelids.

Graves ophthalmopathy Medical condition

Graves’ ophthalmopathy, also known as thyroid eye disease (TED), is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness (erythema), conjunctivitis, and bulging eyes (exophthalmos). It occurs most commonly in individuals with Graves' disease, and less commonly in individuals with Hashimoto's thyroiditis, or in those who are euthyroid.

Orbital cellulitis Inflammation of eye tissues

Orbital cellulitis is inflammation of eye tissues behind the orbital septum. It is most commonly caused by an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood. It may also occur after trauma. When it affects the rear of the eye, it is known as retro-orbital cellulitis.

Endophthalmitis Medical condition

Endophthalmitis is inflammation of the interior cavity of the eye, usually caused by infection. It is a possible complication of all intraocular surgeries, particularly cataract surgery, and can result in loss of vision or loss of the eye itself. Infection can be caused by bacteria or fungi, and is classified as exogenous, or endogenous. Other non-infectious causes include toxins, allergic reactions, and retained intraocular foreign bodies. Intravitreal injections are a rare cause, with an incidence rate usually less than .05%.

Dacryocystitis Medical condition

Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal sac. The term derives from the Greek dákryon (tear), cysta (sac), and -itis (inflammation). It causes pain, redness, and swelling over the inner aspect of the lower eyelid and epiphora. When nasolacrimal duct obstruction is secondary to a congenital barrier it is referred to as dacryocystocele. It is most commonly caused by Staphylococcus aureus and Streptococcus pneumoniae. The most common complication is corneal ulceration, frequently in association with S. pneumoniae. The mainstays of treatment are oral antibiotics, warm compresses, and relief of nasolacrimal duct obstruction by dacryocystorhinostomy.

Orbital blowout fracture Medical condition

An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall, typically resulting from impact of a blunt object larger than the orbital aperture, or eye socket. Most commonly the inferior orbital wall i.e. the floor is likely to collapse, because the bones of the roof and lateral walls are robust. Although the bone forming the medial wall is thinnest, it is buttressed by the bone separating the ethmoidal air cells. The comparatively thin bone of the floor of the orbit and roof of the maxillary sinus has no support and therefore it is the inferior wall that collapses mostly. So the medial wall blowout fractures are second most common, whereas superior wall i.e. the roof and lateral wall blowout fractures are uncommon & rare respectively. There are two broad categories of blowout fractures: open door, which are large, displaced and comminuted, and trapdoor, which are linear, hinged, and minimally displaced. They are characterized by double vision, sunken ocular globes, and loss of sensation of the cheek and upper gums due to infraorbital nerve injury.

Tolosa–Hunt syndrome Medical condition

Tolosa–Hunt syndrome is a rare disorder characterized by severe and unilateral headaches with orbital pain, along with weakness and paralysis (ophthalmoplegia) of certain eye muscles.

Periorbital puffiness

Periorbital puffiness, also known as puffy eyes, or swelling around the eyes, is the appearance of swelling in the tissues around the eyes, called the orbits. It is almost exclusively caused by fluid buildup around the eyes, or periorbital edema. Minor puffiness usually detectable below the eyes only is often called eye bags. Such transient puffiness is distinct from the age related and gradual increase in the size of the fat pad lying below the lower eyelids which can also be colloquially referred to as eye bags.

Dacryocystocele Medical condition

Dacryocystocele (Dacryocystitis) or timo cyst is a benign, bluish-gray mass in the inferomedial canthus that develops within a few days or weeks after birth. The uncommon condition forms as a result as a consequence of narrowing or obstruction of the nasolacrimal duct, usually during prenatal development. Nasolacrimal duct obstruction disrupts the lacrimal drainage system, eventually creating a swelling cyst in the lacrimal sac area by the nasal cavity. The location of the cyst can cause respiratory dysfunction, compromising the airway. The obstruction ultimately leads to epiphora, an abundance of tear production.

Mucormycosis Fungal infection

Mucormycosis, also known as black fungus, is a serious fungal infection, usually in people who are immunocompromised. Symptoms depend on where in the body the infection occurs. It most commonly infects the nose, sinuses, eye, and brain resulting in a runny nose, one-sided facial swelling and pain, headache, fever, blurred vision, bulging or displacement of the eye (proptosis), and tissue death. Other forms of disease may infect the lungs, stomach and intestines, and skin.

Exposure keratopathy is medical condition affecting the cornea of eyes. It can lead to corneal ulceration and permanent loss of vision due to corneal opacity.

Orbital emphysema Medical condition

Orbital emphysema is a medical condition that refers to the trapping of air within the loose subcutaneous around the orbit that is generally characterized by sudden onset swelling and bruising at the impacted eye, with or without deterioration of vision, which the severity depends on the density of air trapped under the orbital soft tissue spaces.

References

  1. "Orbital and periorbital cellulitis". HealthAtoZ.com. East Windsor, NJ: OptumHealth. Archived from the original on 26 June 2008.
  2. Givner LB (December 2002). "Periorbital versus orbital cellulitis". The Pediatric Infectious Disease Journal. 21 (12): 1157–1158. doi:10.1097/00006454-200212000-00014. PMID   12488668.
  3. Botting AM, McIntosh D, Mahadevan M (March 2008). "Paediatric pre- and post-septal peri-orbital infections are different diseases. A retrospective review of 262 cases". International Journal of Pediatric Otorhinolaryngology. 72 (3): 377–383. doi:10.1016/j.ijporl.2007.11.013. PMID   18191234.
  4. Donahue SP, Schwartz G (October 1998). "Preseptal and orbital cellulitis in childhood. A changing microbiologic spectrum". Ophthalmology. 105 (10): 1902–5, discussion 1905–6. doi:10.1016/S0161-6420(98)91038-7. PMID   9787362.
  5. Kornelsen E, Mahant S, Parkin P, Ren LY, Reginald YA, Shah SS, Gill PJ, et al. (Cochrane Eyes and Vision Group) (April 2021). "Corticosteroids for periorbital and orbital cellulitis". The Cochrane Database of Systematic Reviews. 2021 (4): CD013535. doi:10.1002/14651858.CD013535.pub2. PMC   8092453 . PMID   33908631.