Ocular Cellulitis

Question 1

Aetiology:
Preseptal Cellulitis?
Orbital Cellulitis?

Answer 1

preseptal is infection of tissues anterior to orbital septum. In children, orbital septum is weak therefore infection can spread into orbit.

orbital cellulitis is infection of tissues posterior to orbital septum - sight and life threatening

both conditions are causes by staphylococcal and streptococcus bacterias.
in adults, it may be caused by both anaerobic and aerobic bacteria.

Question 2

Predisposing factors:
Preseptal / Orbital

Answer 2

Children vaccinated with HIB vaccine against meningitis are less likely to develop orbital or preseptal ceullitis.

Preseptal:
INSECT BITE
TRAUMA
SURGERY AROUND EYE
IMPETIGO - SKIN INFECTION
DACRYOCYSTITIS
HORDEOLUM
UPPER RESPIRATORY TRACT INFECTION

Orbital:
ACUTE OR CHRONIC SINUSITIS
- secondary to ethmoidal sinus infection in <6
- secondary to ethmoidal, maxillary, and frontal sinus infection in >7
- frontal sinus infection most common in adults
TRAUMA
DACRYOCYSTITIS
PRESEPTAL CELLULITIS
DENTAL ABSCESS
IMMUNE COMPROMISED PEOPLE
DIABETES

Question 3

Symptoms of Preseptal
Symptoms of Orbital

Answer 3

Preseptal
- irritability in children
- fever
- malaise
- acute onset of swelling, redness, and tenderness of eyelid.

Orbital
- sudden onset of severe swelling of conjunctiva and eyelids which can be painful
- pain on eye movement
- blurred and double vision
- fever and severe malaise

Question 4

Signs of Preseptal

Answer 4

Eyelid redness which extends beyond orbital rim in some.
Eyelid oedema, tenderness and warmth
Pyrexia >38 degrees
Ptosis

Question 5

Signs of Orbital

Answer 5

Severe unilateral redness and oedema extending to forehead and cheek.
Ptosis
Proptosis
Reduced vision.
Restricted ocular motility.
Reduced CV.
Abnormal pupil responses.
Pyrexia
Raised IOP.

Question 6

Management of Preseptal Cellulitis

Answer 6

In children, refer same day as emergency.
In adults, start on broad spectrum oral antibiotics such as CO AMOXICLAV. IF penicillin allergy, give Clindamycin.

Coamoxiclav dosage - Co-amoxiclav: 500mg:125mg, one capsule three times per day for 5-7 days.

Question 7

Management of Orbital Cellulitis

Answer 7

In both adults and children, refer SAME DAY as emergency.

Question 8

Management at hospital

Answer 8

Contrast enhanced CT scanning should be done in all patients suspected with orbital cellulitis

For both preseptal and orbital, diagnosis would be confirmed, CT scanning.

Preseptal - systemic antibiotics issued, children may be admitted for observation

Orbital - systemic antibiotics and steroids may be given, admitted to hospital, drainage of orbital abscess, blood tests.