Periorbital Cellulitis

Periorbital cellulitis, also known as preseptal cellulitis, is an acute infection affecting the eyelid and periorbital soft tissues located anterior to the orbital septum. This condition must be distinguished from orbital cellulitis, which involves infection of the orbital tissues located posterior to the orbital septum. The orbital septum, a thin fibrous membrane originating from the periosteum of the orbital rims, acts as an anatomical barrier that prevents the spread of infection between superficial and deeper ocular tissues. Infections located anterior to the septum, such as periorbital cellulitis, are clinically significant because they may progress to more serious orbital or systemic complications if left untreated. Please see StatPearls' companion resource, "Ocular Cellulitis," for more information. The dissemination of infections in the periorbital tissues is influenced by facial structure, including lymphatic drainage and venous linkages. Despite the protective role of the orbital septum, there is still a risk of infection that can spread from the eyelid to deeper regions, particularly in cases of delayed or inadequate treatment. This underscores the importance of prompt assessment and targeted therapy to prevent complications. Periorbital cellulitis can manifest at any age, but it is more prevalent in children aged 5 or younger. The condition usually arises from localized trauma, insect bites, or contiguous dissemination from neighboring structures, such as the paranasal sinuses. The condition typically presents with a sudden onset of erythema, edema, and soreness around the eye, while visual acuity and extraocular movements are preserved. Effective management requires prompt identification, accurate differentiation from orbital cellulitis, and appropriate antibiotic treatment. Although orbital cellulitis may present with similar symptoms, it is characterized by additional ocular signs, such as proptosis, eye pain, decreased vision, and limited extraocular motility. Patients with orbital cellulitis can present with similar findings, but they often exhibit additional ocular symptoms such as proptosis, eye pain, decreased vision, and limited extraocular motility. Distinguishing between periorbital cellulitis and orbital cellulitis is crucial, as treatment and management vary based on the diagnosis. The treatment for periorbital cellulitis typically includes antibiotics targeting the most commonly isolated bacteria, such as and species. Most cases resolve within 5 to 7 days with appropriate antibiotic therapy. However, cases that show resistance to treatment or progress with severe symptoms should be further evaluated for complications, including orbital cellulitis and other potential underlying conditions.