PERIORBITAL CELLULITIS
Karen R Brungard MD
CELLULITIS

PRESEPTAL
OR
 ORBITAL
OBJECTIVES

Define preseptal and orbital cellulitis

Review complications

Discuss workup and treatment options
Imitators
DEFINITION

PRESEPTAL
CELLULITIS is an
infection of the soft
tissue of the eyelids
and periorbital
structures anterior to
the orbital septum

ORBITAL
CELLULITIS is an
infection of the orbital
soft tissue posterior to
the orbital septum
ORBITAL SEPTUM

The orbital septum is a
layer of fascia
extending vertically
from the periosteum of
the orbital rim to the
leavator aponeurosis
of the upper lid and to
the tarsal plate of the
lower lid.
Orbital Anatomy
PATHOGENISIS

Localized eyelid infection
– Hordolea, chalazia, dacryocystitis

Trauma

Dental

Sinusitis
ANATOMY
Orbital Anatomy
Anatomy
Anatomy
Complications of Orbital
Cellulitis

Intracranial 4%
Meningitis 2%
Cavernous sinus thrombosis 1%
Brain, Subdural and Epidural abscess 1%
 Orbital abscess 9%
Subperiosteal abscess 7%
Orbital abscess 2%
 Vision loss 1%
Classification
Description
Group 1
Preseptal
Erythema & edema of
eyelids, normal vision
Group 2
Orbital cellulits
Diffuse edema of orbit,
No abscess
Group 3
Orbital cellulitis with
subperiostal abscess
Abscess adjacent to
lamina papyracea,
proptosis, change in
vision, pain on eye
movement
Group 4
Orbital cellulitis with
abscess in orbital fat
Proptosis, limited
mobility, loss of vision
Group 5
Cavernous sinus
thrombosis
Bilateral disease
COMPARISON
Features
Orbital Cellulitis
Preseptal Cellulitis
Proptosis
Yes
No
Motility
Limited
No
Vision
Decreased
No
Chemosis
Yes
Infrequent
Source
Sinusitis
U.R.I.
Preseptal
Cellulitis
ORBITAL CELLULITIS
Proptosis &Chemosis
Motility
M. catarrhalis
Strep & Staph
Anaerobes
H Flu
MRSA
Maxillary
Acute
chronic
Ethmoid
Acute
chronic
Frontal
Acute
Sphenoid
chronic
Acute
chronic
Aerobic
S aureus
S pneumoniae
H influenza
M catarrhalis
Enterobactiacea
P aeruginosa
4%
31
21
8
7
2
14%
6
5
6
6
3
15%
35
27
8
-
24%
6
6
47
6
33
40
20
-
15%
15
15
8
8
59
18
47
82
-
3
3
3
62
-
38
8
31
6
15
56%
6
12
6
14%
14
28
14
Anaerobic
Peptostreptoccus
P acnes
Fusobacterium
Prevotella
B fragilis
2
2
2
56
29
17
47
6
15
12
4
8
-
19
12
6
6
-
57
29
54
86
-
ORBITAL CELLULITIS
TREATMENT IV UNASYN