Preseptal and Orbital Cellulitis

Abstract

It is important to distinguish between preseptal and orbital cellulitis, as both can present with similar signs and symptoms of red, swollen eyelids, with or without discharge, and with or without upper respiratory symptoms. Decreased visual acuity, afferent pupillary defect, motility deficit, and proptosis suggest an orbital process as opposed to a preseptal cellulitis. Orbital cellulitis can threaten vision and, through optic nerve and meningeal involvement, life. Hence, a high index of suspicion of orbital cellulitis and close monitoring of the response to treatment are crucial in preventing the severe complications of orbital infection. Radiographic imaging such as contrast-enhanced CT or MRI can help determine whether a subperiosteal or orbital abscess is present, or if infection has spread beyond the orbit, resulting in cavernous sinus thrombosis or cerebral abscess. Both preseptal and orbital cellulitis must be treated with systemic antibiotic therapy and monitored with serial ophthalmologic examinations. Surgical intervention may be necessary to drain subperiosteal or orbital abscesses.