Preseptal And Septal Cellulitis

Front 1

What is preseptal cellulitis

What is orbital cellulitis

Back 1

preseptal: infection of soft tissue anterior to orbital septum

orbital: inflammation of orbital contents posterior to orbital septum

Front 2

What are the causes of preseptal cellulitis?

What are the causes of septal cellulitis?

Back 2

preseptal: usually follows periorbital trauma or dermal infection

septal: usually 2° to sinus/facial/tooth infections or trauma, can also arise from preseptal cellulitis. More common in young, elderly, immunocompromised

Front 3

Complications of orbital cellulitis?

Back 3

1. optic nerve inflammation
   
2. cavernous sinus thrombosis
   
3. meningitis
   
4. brain abscess
5. possible loss of vision
   
6. death (17-20% mortality rate without treatment)
   

Front 4

What are the clinical differences between preseptal and orbital cellulitis?

Back 4

• Fever: orbital cellulitis will have fever, preseptal cellulitis may have fever
  
• Conjunctival injection: present in orbital cellulitis only
  
• Chemosis: Marked in orbital cellulitis only
  
• Proptosis: present in orbital cellulitis only
  
• Pain on eye movement: present in orbital cellulitis only
  
• Vision: blurring and diplopia in orbital cellulitis only
  
• RAPD: may be present in orbital cellulitis only
  

• Dental abscess/sinusitis points towards orbital cellulitis
  

• Skin infection points towards preseptal cellulitis
  

• labs:
  
• marked leukocytosis in orbital cellulitis, but moderate leukocytosis in preseptal cellulitis
  
• Elevated ESR in orbital cellulitis, ESR may be elevated in preseptal cellulitis
  

Front 5

Treatment for orbital cellulitis?

Back 5

• admit, blood cultures x2
  
• orbital CT, IV antibiotics (ceftriaxone + vancomycin) for 1 wk
  
• surgical drainage of abscess with close follow-up, especially in children
  

Front 6

Treatment for preseptal cellulitis?

Back 6

• systemic antibiotics (suspect H. influenzae in children; S. aureus or Streptococcus in adults) 􀂃 e.g. amoxicillin-clavulanic acid
  
• if severe or child <1 yr, treat as orbital cellulitis
  

Front 7

What is this? Why?

Back 7

Orbital cellulitis, with conjunctival injection, chemosis, diplopia, proptosis

Front 8

What is this?

Back 8

Preseptal cellulitis