Photographs by The University of Iowa and EyeRounds.org (12) and ©2017 American Academy of Ophthalmology, reprinted with permission. (13, 14).

Better

Best:

Grade I:

Grades II–IV:

 

7. PRESEPTAL AND ORBITAL CELLULITIS

Infection anterior to the orbital septum (usually involving the eyelid) is termed preseptal cellulitis. Preseptal cellulitis will present with tenderness, swelling, and erythema of the eyelids, with no orbital findings (e.g., no sign of proptosis, eye movement restriction, or change in vision). Preseptal cellulitis can generally be managed with oral antibiotics, but the possibility of methicillinresistant Staphylococcus aureus (MRSA) must be considered.

Infection in the orbit (posterior to the orbital septum) can occur as a result of adjacent sinusitis, skin infection, puncture wounds, or orbital foreign bodies. Multiple organisms, including staphylococcal, streptococcal, and gram-negative bacteria, are usually responsible. Orbital cellulitis has the potential to progress rapidly and may lead to irreversible loss of vision or intracranial extension. Orbital cellulitis presents with pain, proptosis, conjunctival injection, decreased vision, and loss of ocular mobility (which may cause double vision).

Goal

Recognize infection early and start oral antibiotics for preseptal cellulitis and IV antibiotics for orbital cellulitis. Evacuate to an eye surgeon as rapidly as possible if orbital cellulitis is suspected.

Preseptal cellulitis (Figure 15)

Best

Trimethoprim sulfamethoxazole DS 1 tablet PO every 8 hours combined with amoxicillin/clavulanic acid 875mg every 12 hours.

Orbital cellulitis (Figure 16)

Minimum

Initiate teleconsultation with photographs (include full facial views).