For Medical students

1. PRESEPTAL AND ORBITAL
CELLULITIS
PRESENTER; NOEL MABELE

2. OUTLINE
• Introduction
• Aetiologies and risk factors
• Clinical presentation
• Investigations
• management

3. Introduction
• Preseptal (periorbital) cellulitis is an
infection of the anterior portion of the
eyelid, not involving the orbit or other
ocular structures.
• Orbital cellulitis is an infection involving
the contents of the orbit (fat & ocular
muscles) but not the globe.
• They are separated by the orbital septum,
a deep fibrous fascia that extends from the
periosteum to the tarsal plate.

5. Aetiologies and risk factors
• Age: Usually child or young adult.
• Sinus infections: frontal, maxillary or
ethmoidal sinusitis (sphenoidal sinusitis is
very rare).
• Orbital injury/ trauma with fracture
intraorbital foreign body.
• Infections in the adjacent skin, insect bites

6. • Post-operative: enucleation of the globe,
strabismus surgery, blepharoplasty, retinal
surgery, .
• Dental, middle ear, nasopharyngeal
infections
• organisms: S. pneumonae, S. aureus,
S.pyogens and H. influenzae,
fungi(Mucorales and Aspergillus spp).

8. Clinical presentations
• Fever, malaise, and a history of recent
sinusitis or upper respiratory tract
infection
•Proptosis and ophthalmoplegia are the
cardinal signs of orbital cellulitis.
•Conjunctival chemosis,
•Decreased vision
•Elevated intraocular pressure

9. Cont……
•Pain on eye movement
•Orbital pain and tenderness
•Swollen eyelids, chemosis, hyperemia of the
conjunctiva, and resistance to retropulsion
of the globe may be present
•Purulent nasal discharge may be present

10. Cont….
• Orbital cellulitis can usually be
distinguished from preseptal by its CF;
opthalmoplegia (paralysis/weakness of eye
muscles) with diplopia, pain with eye
movements, visual impairment and
proptosis, and by imaging studies.
• Chemosis is more commonly in orbital
cellulitis, rarely occur in severe preseptal
cellulitis
• Absence of fever suggests preseptal
cellulitis

12. Investigations
• Visual acuity
• Slit lamp bio microscopy
• Tonometry
• Fundoscopy
• Full Blood Count and ESR
• Blood culture

13. Cont..
• Assessment of purulent nasal discharge or
from the abscess(Swab for Gram Stain)
• CT Scan of the orbits and Para nasal
sinuses with Contrast.
•MRI will help differentiating it with other
diseases but also identifying extension of
the disease

14. Management
• Patient should be admitted immediately.
• Empiric antibiotic therapy is started
promptly:
• The antibiotic will be tailored when the
laboratory results are out.
Adults, give: ampicillin + cloxacillin (IV) 1g
stat then 500mg 6hourly for 2weeks AND
gentamicin (IV) 160mg 24hourly for 7days
AND
metronidazole (IV) 500mg 8hourly for 7days

15. For orbital cellulitis; opthalmologist, ENT
expertise and sometimes surgery is
required
• Vancomycin plus one of the following;
ceftriaxone / cefotaxime
• Anaerobic coverage- metronidazole
• Analgesics for the pain
• surgery- for pt with poor response to
antibiotics or worsening of symptoms and
threatening vision, drainage for
radiologically identified abscesses

16. References
• Oxford specialty training in ophthalmology
textbook
• Basic ophthalmology, Essentials for
medical students.
• Eyewiki.aao.org