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Periorbital (or Preseptal) Cellulitis

The Greek prefix “peri” meaning near, the suffix “itis” meaning inflammation, and “orbit” being the medical term for the eye socket, all together give a good indication of what this disease of the eye is all about:

“a bacterial infection and inflammation of the skin, or tissue under the skin, near the eye socket”.

The range of infections that are periorbital can be grouped into two categories depending where they are prevalent:

  • In the skin tissue (the dermis) around the eye – periorbital cellulitis
  • In the tear ducts – dacryoadenitis, canaliculitis and dacrocystitis

Periorbital cellulitis, sometimes called preseptal cellulitis because the infection occurs in front of the septum, a layer of fibres holding the eyelids in position, can be initiated by quite a few occurrences:

  • A bout of conjunctivitis in the eye spreading to the skin
  • A scratch or an insect bite near the eye becoming infected
  • Sinusitis spreading from the nasal area
  • Bad teeth or poor dental hygiene spreading bacterial infection
  • A stye – a sore bump on the eyelid

 

Who gets it?

Mainly babies up to one year old are found to suffer from the condition, which of course is a source of extreme concern for new parents. Both boys and girls can be affected.

Fortunately it is readily treated and only in exceptional cases is the outcome a bad one.

 

Symptoms

Firstly, there is one symptom that remains missing on the list – vision is NOT affected, (of course this can only be confirmed for certain when young children who may suffer from the condition “agree” to be examined and their sight tested).

“Pink eye” in the white part of the eyes

Elevated temperature or fever, and maybe a runny nose

Swelling of the eyes

Slight breaks in the skin near the eyes

The child appears to be in pain when the eyelids are touched in any way

 

There are a range of possibilities of where the infections come from:

Flu type viruses are increasingly thought to be a factor

A bout of pneumonia

Cosmetics and especially eye makeup not being washed off at night

An instance of meningitis

Contact with staphylococcus or streptococcus bacteria

 

Treatment

Babies and young children need to be taken to hospital.

In the unusual event of an adult being affected, no hospitalisation is required and a course of antibiotics taken orally is a quick and effective treatment, provided the course of antibiotics IS COMPLETED! For that reason alone follow up outpatient care is recommended.

Nasal decongestant sprays can help to clear up a running nose and minimise nasal swelling due to any retention of fluids.

If a diagnosis is made based upon dental hygiene or infection then of course it’s time to leave the ophthalmologist and head for the dentist – hopefully not too far away!

One of the most interesting features of treatment is the ability to quantify the severity through use of an index – the Clinical Severity Index – taking into account and assigning a degree of severity to things such as the extent of swelling, patient temperature, pain suffered and skin appearance. The index can then be used to tailor the treatment accordingly.

 

What’s the outcome?

Although some minor skin scarring may occur in isolated cases, the vast majority of cases in babies clear up – PROVIDED TREATMENT IS SOUGHT! The same occurs in adults, as long as it does not spread posterior of the septum, which can then be serious.

It is essential that treatment is indeed sought, as on rare occasion the periorbital cellulitis may cease to be “near” any more and begin to infect the orbit – orbital cellulitis.

If this does happen further complications can result with an unfortunate prognosis.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

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