Preseptal Cellulitis
An infection of the eyelid and skin around the eye
Quick Facts
- Type: Bacterial skin infection around the eye
- What it affects: Eyelid and skin in front of the eye
- Common signs: Red, swollen, tender eyelid
- Key distinction: Vision and eye movement remain normal
Overview
Preseptal cellulitis, also called periorbital cellulitis, is a bacterial infection of the eyelid and the skin in front of the eye. The name refers to the orbital septum, a thin sheet of tissue that separates the eyelid from the deeper contents of the eye socket. In preseptal cellulitis, the infection stays in front of this barrier and does not involve the eyeball or the muscles and structures behind it.
This distinction is important because preseptal cellulitis is usually less serious than orbital cellulitis, a deeper infection behind the septum that can threaten vision and spread further. Preseptal cellulitis is more common in children and often responds well to antibiotics. Still, it needs prompt medical attention to confirm the diagnosis, start treatment, and make sure the infection has not spread deeper.
Symptoms
Symptoms typically affect one eyelid and the skin around it:
- Redness of the eyelid and surrounding skin
- Swelling that may make it hard to open the eye
- Warmth and tenderness around the eye
- Mild discomfort or pain
- Sometimes a low-grade fever, especially in children
Importantly, in simple preseptal cellulitis the eye itself works normally: vision is clear, the eye moves fully in all directions, and there is no bulging of the eyeball or pain with eye movement. Warning signs that the infection may have spread deeper, such as pain when moving the eye, double vision, reduced vision, or a bulging eye, require urgent evaluation.
Causes
Preseptal cellulitis is usually caused by bacteria reaching the eyelid skin. Common sources include:
- Skin breaks: Cuts, scratches, insect bites, or other injuries near the eye that let bacteria enter.
- Spread from nearby infections: A stye, an infected tear duct, or sinus infection spreading to the eyelid.
- Local skin infections: Such as impetigo around the eye.
The most common bacteria are types of staph and strep that normally live on the skin. In children, infection can sometimes spread from the sinuses, which is one reason careful evaluation is important.
Risk Factors
- Recent injury, scratch, or insect bite near the eye
- Sinus infections, especially in children
- A stye or blocked, infected tear duct
- Skin infections around the face and eyes
- Young age, as the condition is more common in children
- A weakened immune system
Diagnosis
The main goal of diagnosis is to confirm preseptal cellulitis and to distinguish it from the more serious orbital cellulitis. This involves:
- Examination: Checking the eyelid, vision, eye movements, and whether the eye bulges or hurts when it moves.
- History: Asking about recent injuries, insect bites, sinus problems, or other infections.
- Imaging: A CT scan of the eye socket and sinuses may be done when orbital cellulitis is suspected or the picture is unclear, particularly in children or if symptoms are severe.
- Blood or wound tests: Sometimes used to identify the bacteria or assess severity.
Treatment
Treatment centers on antibiotics and close follow-up:
- Oral antibiotics: Most cases in older children and adults are treated with antibiotics taken by mouth, with improvement expected within a couple of days.
- Intravenous antibiotics and hospital care: May be needed for young children, severe cases, or when there is concern that the infection could spread deeper.
- Treating the source: Addressing an underlying stye, blocked tear duct, or sinus infection.
- Close monitoring: Watching for any signs of orbital involvement, such as pain with eye movement, vision changes, or a bulging eye, which would require more intensive treatment.
With prompt treatment, most people recover fully. Stopping antibiotics early or missing follow-up can allow the infection to return or worsen.
Prevention
- Clean and care for any cuts, scratches, or insect bites near the eyes
- Treat sinus infections and styes promptly
- Avoid rubbing or touching the eyes with unwashed hands
- Practice good hand and face hygiene
- Seek care early for skin infections around the face and eyes
When to See a Doctor
See a doctor promptly if you develop a red, swollen, tender eyelid, particularly with fever or after an injury near the eye. Seek urgent or emergency care if there are signs the infection may have spread deeper, including:
- Pain when moving the eye
- Double vision or reduced vision
- A bulging eye or inability to move the eye fully
- High fever or rapidly worsening swelling
- Severe headache or confusion
These features suggest possible orbital cellulitis, which is a more serious infection that needs immediate treatment.
Frequently Asked Questions
How is preseptal cellulitis different from orbital cellulitis?
Preseptal cellulitis affects only the eyelid and skin in front of the eye, and vision and eye movement stay normal. Orbital cellulitis is a deeper infection behind the orbital septum that can cause eye pain with movement, bulging, and vision changes, and it is more serious.
Is preseptal cellulitis serious?
It is usually less serious than orbital cellulitis and often responds well to antibiotics. However, it still needs prompt medical care to confirm the diagnosis, start treatment, and make sure the infection has not spread to deeper structures.
What causes preseptal cellulitis?
It is usually caused by bacteria entering through a break in the skin, such as a cut, scratch, or insect bite near the eye, or by spread from a stye, infected tear duct, or sinus infection. Common bacteria include staph and strep.
How is preseptal cellulitis treated?
Most cases are treated with antibiotics, often taken by mouth, with improvement expected within a couple of days. Young children, severe cases, or those at risk of deeper spread may need intravenous antibiotics and hospital care.
When should I worry about an infected eyelid?
Seek urgent care if you have pain when moving the eye, double or reduced vision, a bulging eye, high fever, or rapidly worsening swelling. These can be signs of orbital cellulitis, which needs immediate treatment.
References
- American Academy of Ophthalmology. Preseptal and orbital cellulitis.
- MedlinePlus, U.S. National Library of Medicine. Periorbital cellulitis.
- Mayo Clinic. Cellulitis.
- Centers for Disease Control and Prevention (CDC). Cellulitis.