What Is Periorbital Cellulitis?

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Periorbital cellulitis is an infection involving the skin around the eye or the eyelid. It is also known as preseptal cellulitis.

A periorbital infection can involve any tissue in the area until it reaches the bony socket. But once the bony tissue is involved, this becomes known as orbital cellulitis. Orbital cellulitis is more serious than periorbital cellulitis because it can quickly lead to vision loss if left untreated. While anybody can have periorbital cellulitis, it most commonly occurs in children under age 5.

This article will discuss symptoms and causes of periorbital cellulitis, how it is diagnosed. and how this can be effectively treated.

Parent checking child for infection around the eye

Amorn Suriyan / Getty Images

Periorbital Cellulitis Symptoms

The symptoms associated with periorbital cellulitis may come on suddenly. They also may be slightly different for everyone. Common symptoms include the following:

  • Eyelid swelling, which can include the upper and/or the lower lid
  • Redness involving the eye area, including the white surface of the eye and the upper and lower lid
  • Fever
  • Pain/soreness

Key signs specific to orbital cellulitis are:

  • Pain with eye movement
  • Blurry or double vision
  • Bulging of the eye

Causes

Typically, periorbital cellulitis develops from a cut or some other trauma to the eye area that enables bacteria to get under the skin and flourish. Sometimes this arises from a bug bite that's infected with bacteria.

If a child has an infection in a nearby area, such as in the sinuses (air-filled spaces near the nose), it can spread to the lid area. It's also possible that a child's upper respiratory tract infection or middle ear infection can spread through the blood to the periorbital area.

While other pathogens may cause issues here, the most common types of bacteria that have been found to be associated with periorbital cellulitis include the following:

Diagnosis

To determine if periorbital cellulitis is the cause of your child's eye problems, the healthcare provider will ask lots of questions to get a full picture of how it may have occurred and will also carefully examine the eye. The diagnosis is usually made based on this exam and symptoms.

It is important to differentiate between periorbital cellulitis and orbital cellulitis as orbital cellulitis threatens sight and requires intravenous antibiotics. If orbital cellulitis is suspected, imaging may be performed, including:

  • A computed tomography scan (CT), involving the use of both X-rays and a computer, produces a detailed, cross-sectional view of the area to help determine the extent of the infection.
  • Magnetic resonance imaging (MRI), a test that can produce a detailed two- and three-dimensional image of the area, using a magnetic field and radio waves, can help show where in the area the infection may be contained.

Treatment

If your child has periorbital cellulitis, treatment will include antibiotic use. In some cases, the infection can be controlled by oral antibiotics. Sometimes, however, your healthcare provider may inject antibiotics.

If there is an external wound associated with the periorbital cellulitis, you may be given antibiotic ointment to apply to it.

If within 48 hours the oral antibiotics are not clearing the infection, or if the healthcare provider is concerned that the orbit itself has become infected, then intravenous antibiotics (IV) will be considered.

Occasionally the antibiotics may need to be administered by IV in a hospital setting for two or three days. Hospitalization is usually required if:

  • The child is under age 2.
  • The person has a fever.
  • The person can't be followed closely on an outpatient basis.

Prognosis

In most cases, patients receiving treatment improve as expected. As long as periorbital cellulitis is diagnosed promptly and properly treated, then recovery is usually straightforward.

If this infection does reach the orbit, otherwise known as the bony socket, however, there can be complications. These can include the following:

  • Vision loss
  • Meningitis, in which there is inflammation of the membranes of the brain and spinal
  • Brain abscess, in which pus becomes collected in the tissue of the brain

The potential for these must be taken seriously. However, such complications are definitely the exception.

Summary

Periorbital cellulitis tends to affect young children under the age of 5. This condition is marked by eyelid swelling, redness, pain and sometimes fever. Periorbital cellulitis can arise from trauma to the eye, such as a cut or even an insect bite. It is usually caused by a bacterial infection.

Once the condition is identified, antibiotics are the mainstay of treatment. In mild cases, oral antibiotics can do the trick. But in more severe cases, IV antibiotics are needed and, in rare instances, must be administered in a hospital.

A Word From Verywell

A periorbital cellulitis infection can come seemingly out of nowhere and look a little scary if the skin around the eye becomes very swollen.

But the good news is that even oral antibiotics alone can be very effective in treating this condition and, If they're needed, other, more potent antibiotic measures can effectively be taken. Before long, the eye should be back to normal.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Mount Sinai. Periorbital cellulitis.

  2. Boston Children's Hospital. Orbital cellulitis.

  3. American Academy of Ophthalmology. Preseptal cellulitis.

  4. Stanford Children's Health. Cellulitis of the eye in children.