Dr Ben Wild
Overview |
The orbital fossa (eye socket) contains numerous tissues including the eye itself, optic nerve, muscles, fat, and much more. The contents of the eye sockets are protected from the elements and held inwards by a membrane called the orbital septum. This membrane extends from the skull to the eyelid margins.
Frontal view of a healthy eye.
Preseptal cellulitis refers to an infection anterior (in front of) the orbital septum deep in the skin of the eyelids. It is much more common than orbital cellulitis and is usually less worrisome, however, it may lead to more serious conditions such as orbital cellulitis, meningitis, or abscess formation.
Frontal view of preseptal cellulitis showing red eyelids.
Orbital cellulitis refers to an infection behind the orbital septum and can be both vision and life threatening. It is most commonly seen in children and usually stems from a sinus infection but can begin through a skin infection, after dental work, from preseptal cellulitis, dacryoadenitis and more.
Frontal view of orbital cellulitis showing a violently red eye, red eyelids, and bulging eye.
Signs and Symptoms |
Signs
Preseptal cellulitis | Unilateral (single side of head) swollen and red eyelids. |
Orbital cellulitis | Unilateral eyelid and eye swelling, red eyelids and eye, abnormal pupil reaction, bulging eye, optic nerve swelling. |
Symptoms
Preseptal cellulitis | Unilateral firm and tender eyelids. |
Orbital cellulitis | Unilateral pain, warm and tender eyelids, feeling ill, possible decreased vision, decreased color vision, double vision, pain on eye movement. |
Causes and Risk Factors |
Causes
Infection.
Risk Factors
Preseptal cellulitis | Skin trauma, insect bite, spread from hordeolum, conjunctivitis. |
Orbital cellulitis | Young age (child), skin infections, dental work, preseptal cellulitis, dacryoadenitis. |
Prevention and Treatment |
Prevention
Seek medical attention for skin, sinus, respiratory tract, and ear infections.
Treatments
Preseptal cellulitis | · Oral antibiotics. · Intravenous antibiotics. |
Orbital cellulitis | · Hospital admission and frequent monitoring. · Intravenous antibiotics. · Check tetanus status. · Perform blood cultures to identify bacteria. · CT or MRI of head to look for brain or sinus abscess. · Possible surgery for abscesses. |
Prognosis |
Preseptal cellulitis is usually an easily treatable condition that requires about 10 days of antibiotics and is not contagious. Orbital cellulitis is vision and life threatening and does necessitate hospital admission and frequent follow ups but timely treatment can drastically increase the odds of a full recovery.