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What is orbital and preseptal cellulitis?

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What is orbital and preseptal cellulitis?

Orbital cellulitis is an uncommon, but severe infection of the muscles and fat behind the eyeball. It does not affect the eyeball.

Orbital cellulitis is an emergency condition that needs fast treatment to prevent serious complications, such as sight loss and meningitis.

It can sometimes be confused with a less severe, but more common condition called periorbital (preseptal) cellulitis. This is because both conditions can cause eye pain, and eyelid swelling and redness.

If you suspect you have orbital cellulitis see a doctor or go to the nearest hospital immediately.

Periorbital cellulitis is an infection of the eyelid and the skin surrounding the eye.

However, unlike orbital cellulitis, periorbital cellulitis does not affect the fat and muscles in the eye socket.

Orbital and periorbital cellulitis - eye infection symptoms

While orbital and periorbital cellulitis are different conditions, they can have similar symptoms.

Both can affect how your eye looks and feels. And both conditions tend to affect 1 eye, although they can sometimes affect both eyes.

Orbital cellulitis symptoms

The symptoms of orbital cellulitis include:

  • eyeball and eyelid swelling
  • eyeball and eyelid redness
  • pain when you move your eye
  • limited eye movement
  • a bulging eye
  • visual problems, such as blurred vision or double vision

Some people with orbital cellulitis may also develop a fever or feel more tired than normal.

Periorbital cellulitis symptoms

Periorbital symptoms include:

  • eyelid swelling that can extend to the eyebrow - without visual problems or bulging eye
  • eyelid redness
  • eyelid tenderness
  • eyelid feels warm
  • upper eyelid drooping

What causes orbital and periorbital cellulitis?

A bacterial sinus infection is the most common cause of orbital cellulitis, but other causes include:

  • a foreign body in the eye
  • breaking the bone around your eye
  • recent eye surgery
  • a tooth, ear, face or eye infection

While a sinus infection is the most common cause of orbital cellulitis, preseptal cellulitis tends to be caused by external factors such as:

  • eye or facial trauma, such as a blow to the face or eyelid surgery
  • insect stings
  • animal bites
  • a foreign body in the eye

How are orbital and periorbital cellulitis diagnosed?

Orbital cellulitis is an emergency condition that can cause sight loss if it is not treated promptly. See a doctor or go to hospital immediately if you think you may have orbital cellulitis.

Your doctor may suspect orbital or periorbital cellulitis based on your symptoms, medical history and an examination of your face and eyes.

Your doctor will usually diagnose periorbital cellulitis without tests. But if they are unsure if you have periorbital or orbital cellulitis, you may be given some tests, including:

  • blood tests - to check for signs of an infection
  • imaging scans - usually a CT scan but an MRI scan may sometimes be used

If your doctor suspects orbital cellulitis, you will most likely be referred to an eye specialist (ophthalmologist) and/or ear, nose and throat (ENT) specialist for treatment.

Treatment for orbital and periorbital cellulitis

Orbital cellulitis is usually treated in hospital with antibiotics, which are given through a vein in the arm (IV).

It’s common to stay in hospital for 7 to 10 days while having antibiotics.

Treatment for orbital cellulitis may also involve:

  • regular eye tests - to monitor your vision
  • medications - including nasal decongestants (if you have a sinus infection) and antifungals (if you have a weak immune system)
  • surgery - in some cases you may need surgery to drain an abscess or any infected fluid collections around the eyes and sinuses

Periorbital cellulitis is treated with antibiotics, usually taken by mouth.

In some cases, you may need to be admitted to hospital for IV antibiotics. This includes if you:

  • have a severe infection
  • are not responding to oral antibiotics
  • are at risk of complications

Complications of orbital and preseptal cellulitis

The most common complication of preseptal cellulitis is orbital cellulitis. This is more likely in young children.

Preseptal cellulitis rarely comes back, but when it does, it is usually due to an underlying cause that was not diagnosed.

Orbital cellulitis can lead to an abscess. This may develop in the eye socket (orbital abscess) or in the wall of the eye socket (subperiosteal abscess).

Other, less common, complications of orbital cellulitis include:

How long will it take to recover from orbital and preseptal cellulitis?

Most people recover from orbital and preseptal cellulitis with antibiotic treatment and symptoms typically begin to improve 24 to 48 hours after starting this treatment.

When can you go back to work after orbital and preseptal cellulitis?

You will need to stay in hospital while receiving treatment for orbital cellulitis. This can last from 1 to 3 weeks. After this time you should be able to return to work, but speak to your doctor to confirm that you are well enough to go back.

If you had preseptal cellulitis that was treated with oral antibiotics as an outpatient, you will usually be able to go back to work sooner.

It can take much longer to recover from orbital cellulitis if you develop complications.

To find answers to any other health questions you might have, visit our Health A-Z.

Date of last review: 1 July 2020

Related articles

Look after your eyes

Eye redness

Eyelid problems

Eye injuries

Exophthalmos (bulging eyes)

References

Uptodate.com. (2020). Orbital cellulitis. [online][Accessed 3 Jan. 2020]. Available here.

Dynamed.com. (2020). Orbital Cellulitis. [online][Accessed 3 Jan. 2020]. Available here.

Lowth, D. (2020). Orbital and Preseptal Cellulitis Medical Information. [online] Patient.info. [Accessed 3 Jan. 2020]. Available here. Bestpractice.bmj.com. (2020). Peri-orbital and orbital cellulitis - Symptoms, diagnosis and treatment | BMJ Best Practice. [online][Accessed 3 Jan. 2020]. Available here.

Dynamed.com. (2020). Preseptal cellulitis. [online][Accessed 3 Jan. 2020]. Available here.

Payne, D. (2020). Abscesses. [online] Patient.info. [Accessed 3 Jan. 2020]. Available here.
NHS.uk. (2020). Cavernous sinus thrombosis. [online][Accessed 9 Jan. 2020]. Available here.

Uptodate.com. (2020). Preseptal cellulitis. [online][Accessed 9 Jan. 2020]. Available here.

Preseptal and Orbital Cellulitis - Eye Disorders - MSD Manual Professional Edition [Internet]. MSD Manual Professional Edition. 2020 [cited 6 March 2020]. Available here.

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