Periorbital Cellulitis: Symptoms, Causes, Treatment

What are the symptoms of periorbital cellulitis?

Periorbital cellulitis, also known as preseptal cellulitis, is an infection that affects the soft tissues around the eye, particularly the eyelids and the skin surrounding the eye socket. Unlike orbital cellulitis, which involves the deeper structures behind the eye, periorbital cellulitis is more superficial and typically less severe, though it still requires prompt treatment to prevent complications. Below are the detailed symptoms associated with periorbital cellulitis:

1. Swelling of the Eyelid

Description: The most noticeable symptom of periorbital cellulitis is swelling of the upper and/or lower eyelid. The swelling can be mild to severe, causing the eyelid to become puffy and enlarged. This may make it difficult to open or close the eye completely.
Location: Swelling is usually confined to the eyelid and the soft tissues around the eye but does not involve the eyeball itself.

2. Redness (Erythema) Around the Eye

Description: The skin around the affected eye becomes red or pink due to inflammation. This redness is often localized to the eyelid and the surrounding tissue, but it does not spread beyond the area around the eye.
Location: The redness typically affects the eyelid and the periorbital region (the skin around the eye socket).

3. Pain or Tenderness

Description: There may be discomfort or pain in the affected area, especially when touching or moving the eyelid. The pain is often described as throbbing or aching and is typically more pronounced when the area is pressed or manipulated.
Location: Pain is localized to the swollen and inflamed tissues around the eye.

4. Warmth Over the Affected Area

Description: The skin over the affected eyelid and surrounding tissue may feel warm or hot to the touch due to inflammation. This is a common symptom of bacterial infections, where the inflamed area becomes warmer than the surrounding skin.
Location: The warmth is typically felt in the eyelid and the periorbital region.

5. Fever

Description: A systemic symptom of periorbital cellulitis may include a mild to moderate fever. This occurs as the body mounts an immune response to the infection. Fever may also be accompanied by chills or malaise (general discomfort).
Severity: Fever is usually low-grade but can vary depending on the severity of the infection and the patient’s overall health.

6. Eye Discharge

Description: Some individuals may experience a yellow or greenish discharge from the eye, especially if the infection has affected the tear ducts. This discharge can cause crusting around the eyelids, particularly after sleeping.
Associated Conditions: Discharge is more common when there is concurrent conjunctivitis (pink eye) or if there is an abscess or collection of pus in the area.

7. Tearing (Epiphora)

Description: Increased tearing or watery eyes can occur as a result of irritation and inflammation. The eye may produce excess tears due to the infection affecting the tear ducts or the conjunctiva (the membrane lining the eyelid and eye surface).
Location: Tearing is typically more noticeable in the affected eye, though both eyes may water as a reflex.

8. Decreased Vision (Rare)

Description: While periorbital cellulitis typically does not affect vision, if the infection is severe or if there is significant swelling, the patient may experience mild blurred vision due to pressure on the eye. However, the eye itself is not usually involved in periorbital cellulitis.
Severity: Any significant visual disturbances may indicate progression to orbital cellulitis, a more serious condition requiring urgent medical attention.

9. Eye Movement Unaffected

Description: Unlike orbital cellulitis, where eye movement is often restricted and painful due to deeper involvement of the eye socket, periorbital cellulitis does not typically impair eye movement. The patient should be able to move the eye in all directions without significant pain or difficulty.
Differentiating Factor: The absence of impaired eye movement helps distinguish periorbital cellulitis from the more dangerous orbital cellulitis.

10. Fatigue and Malaise

Description: As with many infections, periorbital cellulitis may cause the patient to feel generally unwell, tired, or weak. This may be due to the body’s immune response to the infection and the accompanying fever.
Associated Symptoms: Fatigue may be accompanied by a decreased appetite, irritability (especially in children), or difficulty concentrating.

11. Headache (Rare)

Description: Some patients with periorbital cellulitis may develop a headache, especially if there is significant swelling or pressure around the eye. The headache is usually mild and can be caused by tension in the surrounding muscles or general inflammation.
Location: The headache is typically located on the same side as the infected eye, around the forehead or temple area.

12. Enlarged Lymph Nodes

Description: Lymph nodes near the affected area, particularly in the preauricular (in front of the ear) or submandibular (below the jaw) regions, may become swollen and tender. This is a result of the immune system’s response to the infection.
Location: Swollen lymph nodes may be palpable near the ear, jaw, or neck.

13. Abscess Formation (Rare but Possible)

Description: In some cases, periorbital cellulitis may lead to the development of an abscess (a localized collection of pus) in or around the affected area. Abscess formation is more common when the infection is severe or has been left untreated for some time.
Appearance: The abscess may appear as a swollen, red, and painful area that is more localized, with a possible fluctuation or soft spot indicating the presence of pus.

Conclusion

Periorbital cellulitis presents with a range of symptoms, primarily involving localized inflammation, redness, and swelling around the eyelid and surrounding tissues. While it is generally confined to the superficial tissues, it can cause discomfort, pain, and fever. Prompt recognition and treatment are important to prevent the spread of infection to deeper tissues, such as in orbital cellulitis, which can be more serious and lead to complications like vision loss or spread of the infection to the brain.

What are the causes of periorbital cellulitis?

Periorbital cellulitis, also known as preseptal cellulitis, is an infection that affects the eyelid and surrounding skin. The condition is caused by bacteria that invade the skin and tissues around the eye, typically resulting from local or systemic infections. The main causes and risk factors for periorbital cellulitis include:

Primary Causes:

Bacterial Infections:

Staphylococcus aureus: Including methicillin-resistant Staphylococcus aureus (MRSA), is a common cause.
Streptococcus species: Including Streptococcus pneumoniae, which can cause skin infections that lead to periorbital cellulitis.

Contributing Factors and Risk Factors:

Local Skin Infections:

Skin Trauma: Cuts, scratches, insect bites, or other minor injuries around the eye can provide an entry point for bacteria.
Impetigo: A contagious skin infection that often affects children can lead to periorbital cellulitis if it spreads.

Adjacent Infections:

Sinusitis: Infection in the sinuses, especially the ethmoid or maxillary sinuses, can extend to the tissues around the eye, leading to periorbital cellulitis.
Conjunctivitis: Inflammation of the conjunctiva can sometimes lead to infection of the surrounding tissues.

Upper Respiratory Tract Infections:

Infections of the upper respiratory tract can spread to the tissues around the eye, especially in children.

Systemic Conditions:

Bacteremia: The presence of bacteria in the bloodstream can lead to the spread of infection to the periorbital area.

Insect Bites and Allergic Reactions:

Bites or stings near the eye can introduce bacteria and lead to cellulitis.

Skin Conditions:

Eczema or Dermatitis: Chronic skin conditions can compromise the skin barrier, making it easier for bacteria to invade.

Compromised Immune System:

Individuals with weakened immune systems, such as those with diabetes, HIV/AIDS, or undergoing immunosuppressive therapy, are at higher risk of infections, including periorbital cellulitis.

Additional Considerations:

Hematogenous Spread:

In rare cases, bacteria can spread from distant sites of infection through the bloodstream to the periorbital region.

Dental Infections:

Infections from dental sources, though less common, can potentially spread to the periorbital area.

It’s important to note that periorbital cellulitis is a potentially serious condition that requires prompt medical evaluation and treatment to prevent complications, such as the spread of infection to the orbit (orbital cellulitis), which can lead to vision-threatening complications.

How is the diagnosis of periorbital cellulitis made?

The diagnosis of periorbital cellulitis is typically made based on clinical examination and patient history. Given the potential seriousness of the condition and the need to differentiate it from orbital cellulitis, a more severe infection, healthcare providers often use additional diagnostic tests to confirm the diagnosis and assess the extent of the infection. The diagnostic process generally includes the following steps:

1. Patient History:

Symptom Inquiry: The healthcare provider will ask about the onset, duration, and nature of symptoms such as redness, swelling, pain, fever, and any recent infections or trauma.
Medical History: They will review the patient’s medical history, including recent illnesses (like upper respiratory infections or sinusitis), injuries, insect bites, or use of topical medications.

2. Clinical Examination:

Visual Inspection: A thorough examination of the eye and surrounding area will be conducted to assess redness, swelling, warmth, and tenderness.
Palpation: The healthcare provider may gently palpate the area to assess for tenderness and the extent of swelling.
Eye Examination: They will check for signs of more serious conditions like orbital cellulitis, including assessing eye movement, vision changes, and the presence of proptosis (bulging eye).

3. Differential Diagnosis:

Exclusion of Other Conditions: The provider will differentiate periorbital cellulitis from other similar conditions such as orbital cellulitis, allergic reactions, contact dermatitis, or other eye infections.

4. Diagnostic Imaging (if needed):

CT Scan or MRI: In cases where orbital cellulitis or an abscess is suspected, imaging studies such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be ordered. These can help visualize the extent of the infection and determine if it has spread to deeper tissues or structures within the orbit.

5. Laboratory Tests:

Blood Tests: Complete blood count (CBC) may be done to check for signs of infection, such as an elevated white blood cell count.
Blood Cultures: If there is suspicion of a systemic infection or bacteremia, blood cultures may be performed to identify the causative organism.
Swabs or Cultures: If there is discharge or open wounds, swabs may be taken for culture and sensitivity testing to identify the specific bacteria causing the infection and determine the appropriate antibiotic treatment.

6. Assessment of Systemic Symptoms:

Fever and General Symptoms: The presence of fever and systemic symptoms may prompt further evaluation to rule out the spread of infection.

7. Observation and Follow-Up:

Monitoring: The patient’s symptoms and response to treatment are closely monitored to ensure the infection is responding to therapy and to adjust treatment if necessary.

The prompt and accurate diagnosis of periorbital cellulitis is crucial to ensure effective treatment and prevent complications, such as the progression to orbital cellulitis, which can pose a risk to vision and overall health. If you suspect periorbital cellulitis, seek medical attention immediately.

What is the treatment for periorbital cellulitis?

The treatment of periorbital cellulitis aims to eliminate the infection, reduce inflammation, and prevent complications. The approach generally involves antibiotics and supportive care, with the treatment plan tailored based on the severity of the infection and the patient’s overall health. Here’s an overview of the typical treatment strategies:

1. Antibiotic Therapy:

Oral Antibiotics:

For Mild to Moderate Cases:
Amoxicillin-Clavulanate: Commonly prescribed to cover both gram-positive and gram-negative bacteria.
Cephalexin: Another option that provides good coverage for skin and soft tissue infections.
Clindamycin: May be used, especially if MRSA is a concern or the patient has a penicillin allergy.

Intravenous (IV) Antibiotics:

For Severe Cases or Hospitalization:
Vancomycin: Often used in combination with other antibiotics if MRSA is suspected.
Ceftriaxone or Cefotaxime: Broad-spectrum cephalosporins used in more severe infections or when hospitalization is required.

2. Supportive Care:

Warm Compresses: Applying warm compresses to the affected area can help reduce swelling and provide comfort.
Pain Management: Analgesics such as acetaminophen or ibuprofen can be used to manage pain and fever.
Hydration and Rest: Ensuring the patient remains well-hydrated and gets adequate rest to support the immune response.

3. Monitoring and Follow-Up:

Regular Monitoring: Close monitoring of symptoms and response to treatment is crucial. Patients should be re-evaluated within 24 to 48 hours to ensure that the infection is responding to antibiotics.
Adjusting Treatment: If there is no improvement or if the condition worsens, further evaluation and possible adjustment of antibiotics may be necessary.

4. Hospitalization:

Criteria for Hospitalization:
Severe infection with extensive swelling or systemic symptoms (e.g., high fever, malaise).
Patients who are very young (infants) or immunocompromised.
Lack of response to oral antibiotics.

5. Surgical Intervention:

Drainage of Abscess: If an abscess forms or if there is significant concern about the spread of infection, surgical drainage may be required.

6. Prevention of Recurrence:

Address Underlying Conditions: Treating any underlying sinus infections, skin conditions, or other predisposing factors to prevent recurrence.
Good Hygiene Practices: Encouraging good hygiene practices to reduce the risk of skin infections.

Special Considerations:

Differentiating from Orbital Cellulitis: It is essential to differentiate periorbital cellulitis from orbital cellulitis, a more severe condition that requires more aggressive treatment and often hospitalization.

Consultation with Specialists:

Referral to a Specialist: In complex cases or if there are concerns about complications, a referral to an ophthalmologist or infectious disease specialist may be warranted.

Example of a Treatment Plan:

For a patient with mild periorbital cellulitis:

Antibiotic: Oral amoxicillin-clavulanate (Augmentin) for 7-10 days.
Supportive Care: Warm compresses, over-the-counter pain relievers, and adequate rest.
Follow-Up: Re-evaluation within 24-48 hours to assess response to treatment.

For a patient with severe periorbital cellulitis:

Antibiotic: Hospital admission and IV antibiotics such as vancomycin plus ceftriaxone.
Supportive Care: In-hospital monitoring, pain management, and possibly surgical consultation if an abscess is suspected.
Follow-Up: Close monitoring in the hospital with potential transition to oral antibiotics upon improvement.

Prompt medical treatment is crucial to prevent complications such as the spread of infection to the orbit (orbital cellulitis) or the development of abscesses. If you suspect periorbital cellulitis, seek immediate medical attention.