Any positive red flag or clinical suspicion warrants a CT scan of the orbits and sinuses to exclude orbital cellulitis.
If the eye cannot be assessed the patient needs a CT
Preseptal (periorbital) and orbital cellulitis are potentially catastrophic infections near the eye. Preseptal cellulitis is far more common, and although classically reported to be associated with dacryocystitis, sinusitis/upper respiratory infection, trauma/ surgery, or infection from contiguous areas, it can also be associated with insect bites.
Periorbital cellulitis was more frequent (87%) than orbital cellulitis(13%). Periorbital cellulitis is a heterogeneous disease that may complicate trauma to the eyelids, external ocular infection, and upper respiratory infection.
A dental abscess may be the cause of a patient’s preseptal or orbital cellulitis.
Periorbital cellulitis often occurs from a scratch or insect bite around the eye that leads to infection of the skin. Symptoms can include swelling, redness, pain, and tenderness to touch occurring around one eye only. The affected person is able to move the eye in all directions without pain, but there can be difficulty opening the eyelid, often due to swelling. Vision is normal.
Nowhere is there a greater discrepancy between paediatricians and ophthalmologists than in differentiating between periorbital and orbital cellulitis in children. The former tends to be overdiagnosed while the latter is often undertreated.
Periorbital cellulitis (also called preseptal cellulitis) is a serious but treatable infection of the eyelid and tissues around the eyeball. It usually affects only one eye and doesn't travel to the other. It's most common in children younger than 6 years.
Preseptal cellulitis (also called periorbital cellulitis) is an infection of the anterior portion of the eyelid. It does not involve the orbit or other ocular structures. In contrast, orbital cellulitis involves the content of the orbit, but not the globe. Preseptal infections are generally mild, while orbital cellulitis can lead to loss of vision or even loss of life. This describes management of preseptal cellulitis, and also how to rule out more serious orbital involvement. The paranasal sinuses are the main source of orbital infections, but most preseptal cellulitis arises from an external source, such as trauma, insect bites, or foreign bodies.
CT Orbit with IV contrast if: Concern for orbital cellulitis-i.e. equivocal assessment of proptosis, red eye, EOM function or pain w/ eye movement Unable to accurately assess vision (e.g. age <1yr)
Periorbital cellulitis is sometimes called preseptal cellulitis. It is is a skin and soft tissue infection around the eye that is anterior to the orbital septum. Serious complications of periorbital cellulitis are rare, however a more serious condition called orbital cellulitis is sometimes misdiagnosed as periorbital cellulitis. Periorbital cellulitis is most common in children and primarily caused by trauma or sinusitis.