The preseptic cellulite describes an infection of the eyelid and superficial periorbital tissues not involving the eyeball and orbit. It occurs more commonly than the more severe orbital cellulitis, and is generally associated with a more favourable prognosis. Preseptal cellulitis requires, however, an accurate diagnosis for prompt treatment, as the infection can progress to the region behind the orbit and lead to significant visual and CNS complications.
Preseptic cellulite is caused by bacteria, viruses, fungi and helminths. Bacterial infection generally results, by the local extension of an adjacent sinusitis, a dacryocystitis, aeye infection external or from trauma to the eyelids.
Preseptic cellulitis presents with symptoms and signs that often make it confusable with a periorbital abscess. The infection is characterised by the presence of eyelid oedema and erythema, accompanied by heat, reddening or discolouration of the eyelid and sometimes fever. Swelling of the eyelids may lead to difficulty in opening the eyes, however, the infection is superficial and does not extend posteriorly into the orbit. Patients with preseptal cellulitis will therefore present with Normal visual acuity, absence of proptosis and complete ocular motility, without pain on movement.
The assessment of a patient with preseptic cellulitis should include a comprehensive ophthalmic examination, analysing visual acuity, pupillary response, tonometry, anterior segment biomicroscopy and ophthalmoscopy.
Preseptic cellulite treatment
With regard to treatment, considering the predisposing factors, the initial antibiotic therapy must be directed against the pathogens causing sinusitis and upper respiratory tract infections (Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis); however, the epidemiology of aetiological agents must be considered, for example in areas where it is prevalent Staphylococcus aureus resistant to methicillin, the physician should consider adding appropriate alternative antibiotics. In addition, in patients with dirty wounds, infection by bacteria of different species including gram-negatives should be considered. First choice antibiotic therapy should be promptly modified based on clinical response.
Some patients may require hospitalisation with intravenous antibioticsThis is the case, for example, for children under 1 year of age, individuals who do not have immunisation against Haemophilus influenzae e Streptococcus pneumoniaeimmunocompromised patients or those with evidence of severe systemic infection/toxicity.
The prognosis is generally good if the diagnosis is timely and the treatment is correct. The complications that may arise as a result of late or incorrect diagnosis/therapy are:
-extension and orbital complicationssuch as orbital cellulitis, subperiosteal abscess, orbital abscesscavernous sinus thrombosis;
-involvement of the central nervous system (subsequent to orbital extension), with meningitis and abscesses (brain, extradural or subdural);
-necrotizing fasciitis, rarely.
Sources
– Management of preseptal and orbital cellulitis. Seongmu Lee et al. 2011. Saudi Journal of Ophthalmology.
– Preseptal and orbital cellulitis. Tim Ekhlassi et al. 2017. Dis Mon
Dr. Carmelo Chines
Direttore responsabile
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