Periorbital Cellulitis

Periorbital cellulitis is a serious eye infection. It can quickly become a vision-threatening ophthalmic emergency if not treated. This infection affects the delicate tissues around the eye, like the eyelids and skin.

It’s important to recognize the signs and symptoms of periorbital cellulitis. This is key to getting medical help quickly. Knowing what causes it can also help prevent it.

We will explore the definition, causes, symptoms, diagnosis, and treatment of periorbital cellulitis. Understanding this eye infection is vital for protecting your vision and eye health.

What is Periorbital Cellulitis?

Periorbital cellulitis, also known as preseptal cellulitis, is a bacterial infection. It affects the tissues around the eye, like the eyelids and skin. This condition is common in children but can happen to anyone.

This infection often starts as a complication of sinusitis. It spreads from the sinuses to the area around the eye. It can also be caused by trauma, insect bites, or dental infections. People with weakened immune systems, diabetes, or recent colds are more at risk.

Definition and Overview

Periorbital cellulitis causes inflammation and swelling of the eyelids and skin. It’s important to tell it apart from orbital cellulitis. Orbital cellulitis affects deeper tissues and can be more serious if not treated.

The infection is usually caused by bacteria like Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae. These bacteria can get into the tissues around the eye through various ways, like from sinuses or skin trauma.

Causes and Risk Factors

The main cause of periorbital cellulitis is sinusitis, often ethmoid sinusitis. When the infection moves to the soft tissues around the eye, it can spread fast and cause a lot of inflammation. Other causes include:

• Trauma to the eyelids or surrounding skin
• Insect bites near the eye
• Dental infections that spread to the periorbital area
• Dacryocystitis (infection of the lacrimal sac)
• Impetigo or other skin infections near the eye

Some factors can make you more likely to get periorbital cellulitis. These include:

• Weakened immune system due to conditions like diabetes or HIV
• Recent upper respiratory tract infections
• Allergic rhinitis or chronic sinusitis
• Poor hygiene practices
• Young age (children are more susceptible)

Quickly treating sinusitis and other risk factors can help stop periorbital cellulitis. This can prevent its serious complications.

Symptoms and Signs of Periorbital Cellulitis

Periorbital cellulitis shows clear symptoms that doctors use to diagnose it. People with this eye infection often feel uncomfortable and see changes around their eye.

Common Presenting Symptoms

The main symptoms of periorbital cellulitis are:

• Eyelid swelling: The eyelids get puffy and hard to open.
• Redness and tenderness: The skin around the eye turns red and hurts when touched.
• Pain: People may feel pain or pressure around their eye.
• Fever: A low-grade fever often comes with periorbital cellulitis.

Physical Examination Findings

Doctors look for specific signs during a physical exam, like:

• Eyelid erythema and edema: The eyelids look red and swollen.
• Conjunctival injection: The white part of the eye may look red or “bloodshot.”
• Discharge: Pus or mucus might drain from the eye.
• Restricted eye movements: Eyelid swelling and pain make it hard to move the eye.

Spotting these eye infection symptoms early helps doctors treat periorbital cellulitis quickly. While eyelid swelling is a key sign, other symptoms help doctors tell it apart from other infections. Quick action is important to avoid serious problems and help the patient get better.

Diagnosing Periorbital Cellulitis

Getting a correct periorbital cellulitis diagnosis is key to treating it quickly and avoiding worse problems. Doctors use a detailed check-up, blood tests, and imaging to find out if there’s an infection and how big it is.

Doctors check for swelling, redness, warmth, and tenderness in the eyelids. They also test how well you can see, move your eyes, and react to light. Blood tests, like a complete blood count (CBC) and C-reactive protein (CRP), show how serious the infection is.

Imaging studies are very important for diagnosing periorbital cellulitis. They help tell if the infection is just in the eyelids or if it’s deeper. Computed tomography (CT) scans are best because they show detailed pictures of the soft tissues and sinuses.

CT scans can show signs of periorbital cellulitis, like swelling in the soft tissues and sinus problems. They can also rule out more serious infections in the orbit. Here’s what they might find:

In some cases, doctors might use magnetic resonance imaging (MRI) for better soft tissue detail. MRI can show how far the inflammation has spread and if it’s reached the brain. But, CT scans are usually the first choice because they’re more available and quicker.

Doctors use all the information from the check-up, blood tests, and imaging to make a correct diagnosis. Starting treatment early is very important. It helps stop the infection from getting worse and causing serious problems in the orbit or brain.

Differentiating Periorbital Cellulitis from Other Orbital Infections

To diagnose periorbital cellulitis correctly, we must carefully differential diagnosis. This helps us rule out other orbital infections that might look similar. We need to think about preseptal cellulitis and orbital cellulitis.

Preseptal Cellulitis vs. Orbital Cellulitis

Preseptal cellulitis and orbital cellulitis both cause swelling around the eye. But they are different in where they happen and how bad they are. Preseptal cellulitis is in the skin and soft tissues before the orbital septum. Orbital cellulitis is deeper, behind the septum.

The table below shows what makes these two conditions different:

Distinguishing Features and Diagnostic Tests

Imaging studies are key in differential diagnosis of periorbital cellulitis and orbital cellulitis. CT scans show how far the infection has spread and if there are abscesses or sinusitis. MRI helps see soft tissue and any brain problems.

Lab tests like complete blood count, blood cultures, and wound cultures are also important. They tell us what’s causing the infection and help choose the right antibiotics. A detailed differential diagnosis is vital for quick and right treatment.

Complications of Untreated Periorbital Cellulitis

Periorbital cellulitis is treatable, but quick action is key to avoid serious issues. If not treated, it can quickly get worse. This could harm your vision or even your life.

Orbital Abscess Formation

An orbital abscess is a big worry with periorbital cellulitis. It happens when the infection goes deeper and pus builds up. This causes a lot of pain, makes the eye bulge, and limits eye movement.

If not treated, an orbital abscess can damage your vision. It can press on the optic nerve or cut off blood to the retina.

Intracranial Extension and Sepsis

In severe cases, the infection can spread to the brain. This can cause meningitis or brain abscesses. Signs include a bad headache, changes in mental state, and problems with movement.

The infection can also get into the blood, causing sepsis. Sepsis is a serious condition that can lead to organ failure and shock. It needs quick treatment with antibiotics.

It’s vital to catch these serious periorbital cellulitis complications early. Watch for signs of orbital abscess, brain issues, or sepsis. This helps manage the condition and protect patients’ health.

Treatment Strategies for Periorbital Cellulitis

Effective treatment for periorbital cellulitis includes antibiotics, supportive care, and sometimes surgery. The main goal is to get rid of the infection and help the patient recover.

Antibiotic Therapy: Intravenous and Oral

Intravenous antibiotics are key in treating periorbital cellulitis early on. Doctors often use broad-spectrum antibiotics like ceftriaxone or ampicillin-sulbactam. For methicillin-resistant Staphylococcus aureus (MRSA), vancomycin is added.

When the patient gets better, they might switch to oral antibiotics. This could be amoxicillin-clavulanate or clindamycin to finish the treatment.

Supportive Care Measures

Supportive care is also important in treating periorbital cellulitis. It includes:

• Warm compresses to reduce swelling and discomfort
• Analgesics and anti-inflammatory medications for pain relief
• Nasal decongestants to improve sinus drainage
• Monitoring of visual acuity and eye movements

Surgical Interventions for Severe Cases

Surgery is needed for severe cases of periorbital cellulitis. Orbital decompression surgery is done for orbital abscess, increased eye pressure, or fast-spreading infection. The surgery creates incisions to drain the abscess and relieve eye pressure.

Combining surgery with intravenous antibiotics is key. It helps prevent vision loss and serious complications.

The Role of Imaging in Periorbital Cellulitis Management

Imaging studies are key in managing periorbital cellulitis. They help doctors see how far the infection has spread. This guides their treatment plans. CT scans and MRI are the main imaging tools used.

CT scans are often the first choice for suspected periorbital cellulitis. They show detailed images of the orbit’s soft tissues and bones. Doctors can check for inflammation, abscesses, or if nearby areas like sinuses or the brain are affected. The advantages of CT scans include:

In some cases, MRI might be better than CT for looking at periorbital cellulitis. MRI gives better images of soft tissues and can show how far the infection has spread. It’s good for seeing the optic nerve or cavernous sinus. But, MRI takes longer and might need sedation for young kids.

Imaging studies give important details about the severity and complications of periorbital cellulitis. Patients with abscesses or intracranial extension on CT or MRI usually need stronger treatments, like IV antibiotics and surgery. On the other hand, those with just preseptal inflammation might get oral antibiotics and be watched closely as outpatients.

Preventing Periorbital Cellulitis: Addressing Risk Factors

To prevent periorbital cellulitis, we must tackle the main risk factors. These include sinusitis and dental infections. Early treatment of these can greatly lower the risk of getting this infection.

Prompt Treatment of Sinusitis and Dental Infections

Treating sinusitis often means using antibiotics, decongestants, and pain relievers. For long-lasting or frequent sinusitis, surgery might be needed. It helps improve how the sinuses drain.

For dental infections, treatment includes antibiotics, draining abscesses, and sometimes removing infected teeth. Acting quickly can stop the infection from spreading to the eyes.

Immunizations and Hygiene Practices

Vaccines are key in preventing periorbital cellulitis. Shots against Haemophilus influenzae type B (Hib), Streptococcus pneumoniae, and measles protect against infections. Keeping hands clean and avoiding touching the face also helps prevent bacteria from reaching the eyes.