Periorbital Cellulitis
Infection of the eyelid and skin around the eye
Quick Facts
- Type: Eye-area skin infection
- Location: Eyelid and skin in front of the eye socket
- Common in: Children
- Key concern: Distinguishing it from orbital cellulitis
Overview
Periorbital cellulitis, also called preseptal cellulitis, is a bacterial infection of the eyelid and the skin and soft tissue around the eye, in the area in front of the eye socket. It causes redness, swelling, and tenderness of the eyelid and surrounding skin.
The most important task in evaluating this infection is to separate it from orbital cellulitis, a more serious infection that involves the deeper tissues behind the eye socket. Periorbital cellulitis is generally less dangerous and often treated with antibiotics, but because the two can look similar early on and because orbital cellulitis can threaten vision, prompt medical assessment is important, especially in children.
Symptoms
Periorbital cellulitis typically causes:
- Redness and swelling of one eyelid and the surrounding skin
- Tenderness and warmth over the area
- The eyelid may be swollen shut
- Mild discomfort
Importantly, with simple periorbital cellulitis the eye itself moves normally, vision is unaffected, and the eye is not bulging. Warning signs that suggest the more serious orbital cellulitis, which is an emergency, include pain with eye movement, double or reduced vision, a bulging eye, restricted eye movement, fever, and feeling very unwell.
Causes
Periorbital cellulitis is caused by bacteria entering the skin and soft tissue around the eye. Common routes include:
- Breaks in the skin: Scratches, insect bites, or minor injuries near the eye
- Spread from nearby infections: Such as sinus infections, styes, or conjunctivitis
- Dental or skin infections in the area
Several types of bacteria can be responsible. Children are affected more often than adults.
Risk Factors
- Young age (children are most commonly affected)
- Recent sinus infection
- Skin injury, insect bite, or stye near the eye
- Conjunctivitis or other nearby infection
- Weakened immune system
Diagnosis
Diagnosis focuses on confirming the infection and ruling out orbital involvement:
- Examination of the eyelid, eye movements, vision, and whether the eye bulges, to distinguish periorbital from orbital cellulitis.
- Blood tests in some cases to assess for infection.
- CT scan of the eye socket and sinuses when orbital cellulitis is suspected, the diagnosis is uncertain, or the person is not improving.
- Cultures of any wound or discharge to identify the bacteria.
Treatment
Treatment is with antibiotics, and the setting depends on severity and age:
- Oral antibiotics: Many milder cases, especially in older children and adults, are treated with oral antibiotics and close follow-up.
- Hospital and intravenous antibiotics: Used for young children, severe cases, those not improving, or when orbital cellulitis cannot be excluded.
- Treating the source: Such as a sinus infection or skin wound.
- Close monitoring: Watching for any signs of progression to orbital cellulitis, which would require more aggressive treatment and sometimes surgery.
With prompt antibiotic treatment, most people with periorbital cellulitis recover well.
Prevention
- Clean and care for any cuts, scratches, or insect bites near the eye
- Treat sinus infections, styes, and conjunctivitis promptly
- Practice good hand and face hygiene
- Keep recommended childhood vaccinations up to date
- Seek care early if redness and swelling around the eye develop
When to See a Doctor
See a doctor promptly for redness and swelling around the eye, especially in a child. Seek emergency care if there are signs of the more serious orbital cellulitis:
- Pain when moving the eye, or limited eye movement
- Double vision or reduced vision
- A bulging eye
- High fever or feeling very unwell
Because the two infections can look similar early and orbital cellulitis can threaten sight, do not delay evaluation.
Frequently Asked Questions
What is the difference between periorbital and orbital cellulitis?
Periorbital (preseptal) cellulitis affects the eyelid and skin in front of the eye socket, with normal eye movement and vision. Orbital cellulitis is a deeper, more dangerous infection behind the socket that can cause painful eye movement, vision changes, and a bulging eye, and it is a medical emergency.
Is periorbital cellulitis serious?
It is usually less serious than orbital cellulitis and often responds well to antibiotics. However, because it can be hard to tell apart from orbital cellulitis early on, and because the latter can threaten vision, prompt medical assessment is important.
What causes periorbital cellulitis?
It is a bacterial infection that usually starts from a break in the skin near the eye, such as a scratch, insect bite, or stye, or from spread of a nearby infection like sinusitis or conjunctivitis. Children are most commonly affected.
How is periorbital cellulitis treated?
Treatment is with antibiotics, either by mouth for milder cases with close follow-up or intravenously in hospital for young children, severe cases, or when orbital cellulitis cannot be ruled out. The underlying source, such as a sinus infection, is also treated.
When should I take my child to the emergency room?
Seek emergency care if a child with eye-area swelling develops pain on eye movement, limited eye movement, double or reduced vision, a bulging eye, or high fever. These suggest orbital cellulitis, which needs urgent treatment.
References
- MedlinePlus, U.S. National Library of Medicine.
- American Academy of Ophthalmology. Preseptal and orbital cellulitis.
- Merck Manual. Preseptal and orbital cellulitis.
- StatPearls, National Library of Medicine. Periorbital cellulitis.