Peri-orbital cellulitis

• Peri-orbital cellulitis (also called pre-septal cellulitis) is an infection in the eyelid tissues anterior to the orbital septum.
• Peri-orbital cellulitis is a much more common and less serious than orbital cellulitis.
• Causes:

  • Superficial injury e.g. inset bite, chalazion and conjunctivitis
  • Secondary to URTI
  • Secondary to sinusitis
• Symptoms:

  • Pain
  • Redness
  • Swelling of the eyelid
• Other important areas to cover in the history include:

  • Recent insect bites, styes/chalazions, recent upper respiratory tract infections
• Typical clinical features of peri-orbital cellulitis include:

  • Eyelid redness, mild tenderness and swelling
  • Fever
• Unlike orbital cellulitis, patients with peri-orbital cellulitis are unlikely to experience significant pain.
• Important negatives:

  • Normal visual acuity and fields
  • No pain on eye movement
  • Colour vision will be intact
  • No signs of chemosis or proptosis
• Consider emergency referral to ophthalmology/ENT if there is any suspicion of orbital cellulitis, the patient is systemically unwell, or not responding to treatment
• Paediatric patients should be urgently referred as they require empirical intravenous antibiotic treatment and daily review due to the difficulty in differentiating between orbital and peri-orbital cellulitis. 
• Management:

  • Oral co-amoxiclav first line
  • Follow up review in 24-48 hours
  • Safety netting
  • Is sinogenic cause is suspected then patients require intranasal treatment
• Peri-orbital cellulitis can spread to cause orbital cellulitis and its subsequent sequelae. As a result, it is important to provide adequate safety netting advice to patients with peri-orbital cellulitis.