Preseptal and Orbital Cellulitis

Abstract

Preseptal and orbital cellulitis are infections of the soft tissues of the orbit that can occur in both children and adults. In preseptal cellulitis, infection is limited to the area anterior to the orbital septum, whereas orbital cellulitis affects the tissues posterior to this anatomic landmark. These infections are most commonly caused by Haemophilus, Staphylococcus, and Streptococcus species; however, with immunization against H. influenzae type B (Hib), infection with this organism is becoming less common. 1–3 Peak occurrence in children has been reported at ages 2 to 4 years. 4,5 In retrospective analyses of hospitalized pediatric patients, most patients had preseptal cellulitis (85%–95%) as compared with orbital cellulitis (5%–15%). 1,2,4,6,7 Patients with preseptal or orbital cellulitis present with similar symptoms, such as eye pain, periorbital swelling, and/or fever. It is important to differentiate between the 2 infections because the treatment for each is different, with orbital cellulitis warranting a more ag­ gressive approach that includes parenteral antibiotics and surgical consultation. If left untreated, complica­ tions of preseptal and orbital cellulitis include blindness, meningitis, and death. 8 This article reviews the clinical presentation of preseptal and orbital cellulitis, how to differentiate between the 2 infections, and appropriate management strategies to prevent complications.