Periorbital (Preseptal) Cellulitis

What is periorbital cellulitis (preseptal cellulitis)?

Periorbital cellulitis is a bacterial (or viral) infection in your eyelid or the skin around your eye. Peri- means “around,” so periorbital means “surrounding your orbit,” which is your eye socket. This condition mostly affects young children. It makes the skin around their eyes puffy and swollen. But it usually doesn’t cause discomfort. It’s a superficial skin infection that goes away quickly with antibiotics.

Cellulitis isn’t always superficial — it can sometimes spread to the deeper layers of your skin and the tissues beneath it. This is why healthcare providers have begun using the term, “preseptal cellulitis” to describe periorbital cellulitis. “Preseptal” means “in front of the septum,” which is the membrane that separates the skin around your eyes from the other tissues that lie deeper inside your eye socket.

Preseptal cellulitis could become a more serious condition if the infection spreads beyond the septum, to the deeper layers of skin and other tissues in your eye socket (orbit). This is called orbital cellulitis. It causes additional symptoms and is much more dangerous than periorbital cellulitis. If you or your child develops a fever with pain and swelling all around the eye socket, you should seek immediate care.

Symptoms of periorbital cellulitis

Periorbital cellulitis symptoms may include:

• Swollen eyelid or swelling around your eye
• Redness or discoloration around your eye
• Skin around your eye feeling tender to touch

It doesn’t cause eye pain or fever. Swelling occurs in the skin, but not in the deeper tissues around or behind the eye. Swelling behind the eye can make it bulge, which is one way to tell the difference.

Preseptal cellulitis causes

Bacteria that infect the skin around your eye usually cause preseptal cellulitis. They often get into your skin from a sinus infection or a flesh wound. Sometimes, the infection spreads from somewhere else.

They may come from:

• Animal bites
• Bug bites
• Eye infections
• Sinus infections
• Scratches or cuts
• A blocked and infected tear duct

Risk factors of preseptal cellulitis

Your child might be more likely to get preseptal cellulitis if they:

• Are younger than 5
• Are immunocompromised
• Haven’t had the Hib vaccine

Is periorbital cellulitis contagious?

Periorbital cellulitis isn’t contagious. Since the infection is within your skin, it won’t spread by contact with another person. If your child had an open, infected wound, the bacteria in that wound could spread by contact with another person. But it wouldn’t cause an infection unless they also had an open wound.

How doctors diagnose periorbital cellulitis

To diagnose periorbital (preseptal) cellulitis, healthcare provider will examine the area around your child’s eye. They’ll ask about any recent injuries, bites or infections. They might order imaging tests, like a CT scan or MRI, to see the deeper tissues around the eye if the area is very swollen. They might want to take a sample of infected fluids, like eye discharge or nasal discharge, to do a bacterial culture test.

How is periorbital cellulitis treated?

Periorbital cellulitis needs treatment with antibiotics. In most cases, your child can take them in pill form at home. The infection usually goes away after about a week. If your child has a really bad infection, or their immune system is weaker for any reason, your provider might prefer that they stay in the hospital and receive antibiotics through a tube in their vein (IV). This gets the medicine to their tissues faster.

When should I see my healthcare provider about preseptal cellulitis?

Contact your provider right away when you notice symptoms of periorbital cellulitis. Although it isn’t serious itself, it can turn into a more serious condition if it doesn’t get prompt treatment. Be sure to contact your provider if your child’s symptoms aren’t improving with treatment, or if they get worse.

Go to the emergency room if your child develops:

• A fever
• Eye pain
• Vision changes
• Bulging of the eye

What questions should I ask my provider?

You might want to ask:

• Does my child have periorbital cellulitis or another condition?
• Will they need tests to rule out orbital cellulitis?
• Which antibiotics will they need?
• How long will my child need to take antibiotics?

What can I do to prevent periorbital cellulitis?

You can reduce your child’s risk of periorbital cellulitis if you:

• Clean and disinfect cuts, scrapes and bites right away
• Teach your child to wash their hands and avoid touching their eyes
• Take common infections seriously and seek treatment if they don’t improve
• Consult your child’s pediatrician about which vaccines they recommend and why