Preseptal Cellulitis

4 min read

Preseptal cellulitis is an infection of the preseptal tissue of the eyelid. It can happen in the upper eyelid, the lower eyelid, or in both the upper and lower eyelid. It tends to happen on one side, but there are cases of bilateral preseptal cellulitis.

It is called preseptal because the parts of the eyelid that are affected are anterior to a part of the eyelid called the orbital septum. The orbital septum separates the preseptal tissue from the postseptal tissue. If the infection from preseptal cellulitis extends to the postseptal tissue, then the condition is called orbital cellulitis. Orbital cellulitis is a very serious eye condition that often requires overnight hospital admission.

Preseptal Vs Orbital Cellulitis

Preseptal cellulitis looks like redness and swelling of the eyelid. It can almost appear as if the skin of the eyelid is stretched and shiny. In severe cases of preseptal cellulitis the eyelids could become very swollen, making it hard for someone to open their eyes. 

The movements of the eyes should not be affected by preseptal cellulitis. This means that a patient with preseptal cellulitis should be able to move their eyeball left, right, up and down. There may be some mild restriction if they eyelid swelling is significant. If eye movements are significantly affected, this could be a sign that the preseptal cellulitis has progressed to orbital cellulitis. 

A patient’s vision and pupils should not be affected by preseptal cellulitis. If a doctor notes a significant decrease in vision or a pupillary abnormality, this could also mean that the preseptal cellulitis has progressed to orbital cellulitis.

In some cases, patients can also have a fever. A fever is a more concerning symptom and these patients should be watched closely for the development of orbital cellulitis.

Most patients with preseptal cellulitis will likely report some pain or discomfort. This pain is likely related to the eyelid swelling and any eyelid tightness. In some cases, the swollen eyelid can place pressure on the eyeball and cause the pressure inside the eye to go up. In these cases, some patients may experience pain from the this rise in pressure. It is important to have your eye pressure checked if you have preseptal cellulitis.

The signs and symptoms of preseptal cellulitis can sometimes be difficult to distinguish from orbital cellulitis. If this is the case, your doctor may want to order some imaging of your eye and your orbit. A CT scan can help the doctor to see where exactly the infection and inflammation from preseptal cellulitis has extended to. It can also help to locate an abscess (a collection of pus or infection) if there is one. If there is an abscess found on imagine, it means that it is orbital cellulitis.

Preseptal Cellulitis Treatment

The severity of your preseptal cellulitis will determine how often you are seen by a doctor. In severe cases, the doctor may examine you daily or even multiple times during the day. In less severe cases, the doctor may see you back after one or two days, while on treatment.

The majority of preseptal cellulitis is caused by bacteria. Therefore, patients are often on antibiotics. In severe cases, the patient may be hospitalized and given intravenous (IV) antibiotics. In less severe cases, oral antibiotics may be enough to treat the infection. If an abscess is found on an imaging study then it is very likely that the abscess will need to be drained. 

Sources:

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https://pubmed.ncbi.nlm.nih.gov/29261970/

Mouriaux F, Rysanek B, Babin E, Cattoir V. Les cellulites orbitaires [Orbital cellulitis]. J Fr Ophtalmol. 2012 Jan;35(1):52-7. French. doi: 10.1016/j.jfo.2011.08.004. Epub 2012 Jan 4. PMID: 22221713.

https://pubmed.ncbi.nlm.nih.gov/22221713/

Tsirouki T, Dastiridou AI, Ibánez Flores N, Cerpa JC, Moschos MM, Brazitikos P, Androudi S. Orbital cellulitis. Surv Ophthalmol. 2018 Jul-Aug;63(4):534-553. doi: 10.1016/j.survophthal.2017.12.001. Epub 2017 Dec 15. PMID: 29248536.

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