OVERVIEW

What is periorbital cellulitis?

Periorbital cellulitis, also known as preseptal cellulitis, differs anatomically from orbital cellulitis as it is more superficial, affecting only the soft tissues anterior to the orbital septum without involving deeper structures or the eyeball.

It is typically caused by sinusitis, local trauma, insect or animal bites, or foreign objects penetrating the facial and eyelid soft tissues. Patients usually experience symptoms such as unilateral eye pain, eyelid redness, and swelling, with rare severe complications.

Treatment primarily involves oral antibiotics and usually does not require hospitalization unless the condition is severe or the patient is a young child unable to cooperate with examinations. With proper medication, symptoms of periorbital cellulitis resolve quickly. The antibiotic course typically lasts 5–7 days, but if symptoms persist, treatment should continue until eyelid redness and swelling subside.

Overall, periorbital cellulitis can range from mild to severe and requires careful attention. Systematic medication under a doctor's guidance is essential, and recurrence after cure is rare.

Is periorbital cellulitis common?

Periorbital cellulitis occurs more frequently in children and is less common in adults.

Are periorbital cellulitis and orbital cellulitis the same condition?

No.

Periorbital cellulitis is a more common eye infection, sharing some symptoms with orbital cellulitis, such as eye pain and eyelid swelling and redness. However, periorbital cellulitis only affects the eyelids, whereas orbital cellulitis involves deeper tissues around the eyeball and is more severe.

SYMPTOMS

What are the common manifestations of periorbital cellulitis?

Symptoms include:

• Unilateral eyelid swelling and redness;
• Unilateral eye pain;
• Fever or absence of fever, with leukocytosis shown in blood tests;
• Rare severe cases may present with conjunctival swelling;
• No ocular muscle paralysis, pain with eye movement, or proptosis.

What serious consequences can periorbital cellulitis cause?

Periorbital cellulitis rarely leads to severe complications. In rare severe cases, conjunctival swelling may occur, but it typically resolves with effective treatment.

CAUSES

What are the common causes of periorbital cellulitis?

Periorbital cellulitis is a disease caused by bacterial infection through various routes. The infection most commonly originates from sinusitis, but there are other causes as well, such as:

• Eye surgery (e.g., strabismus surgery, blepharoplasty, etc.).
• Infection caused by foreign objects invading the soft tissues near the face and eyelids.
• Acute dacryocystitis due to blocked tear ducts, which may lead to periorbital cellulitis.
• Upper respiratory tract infections (the upper respiratory tract includes the nose, pharynx, and larynx).
• Insect or animal bites.

DIAGNOSIS

How is periorbital cellulitis diagnosed?

When diagnosing periorbital cellulitis, doctors primarily rely on the patient's clinical manifestations. As long as the patient presents with eyelid redness and swelling, and orbital cellulitis is ruled out, a diagnosis of periorbital cellulitis can be made.

However, if orbital cellulitis cannot be excluded, imaging tests are required for confirmation.

Is blood culture necessary for periorbital cellulitis?

Generally, blood culture is not required because bacteria are rarely detected in such cases. However, for very young patients, those with fever, or cases where orbital cellulitis cannot be completely ruled out, blood culture may be performed to aid diagnosis and guide treatment.

Under what circumstances is orbital and sinus CT imaging needed for diagnosing periorbital cellulitis?

• Orbital and sinus CT imaging is necessary when orbital cellulitis cannot be clearly ruled out.
• Children under 1 year of age or those unable to cooperate for a comprehensive examination may also require orbital and sinus CT imaging due to difficulties in assessing their condition.

What conditions can periorbital cellulitis be confused with, and how can they be distinguished?

• Periorbital cellulitis is easily confused with orbital cellulitis. In terms of symptoms, periorbital cellulitis only affects the eyelids, not the orbit, and the symptoms are much milder. Symptoms such as ocular muscle paralysis, pain during eye movement, and proptosis usually indicate orbital cellulitis.
• Periorbital cellulitis may be mistaken for an allergic reaction caused by eye medications, which can be distinguished by carefully inquiring about the patient's history of allergen exposure.
• Periorbital cellulitis can also be confused with hordeolum (stye) and chalazion. In ocular manifestations, hordeolum and chalazion typically present as discrete nodules.

TREATMENT

Which department should I visit for periorbital cellulitis?

Ophthalmology or ENT (Ear, Nose, and Throat).

Can periorbital cellulitis heal on its own?

Periorbital cellulitis requires active antibiotic treatment and will not resolve without antimicrobial medication.

How is periorbital cellulitis treated?

Treatment primarily involves antibiotics, usually administered orally or intravenously. Topical antibiotic eye drops alone are generally ineffective. Specific treatments include:

• Oral antibiotics: Suitable for mild cases in adults and children over 1 year old without systemic toxicity. Outpatient treatment is possible with close follow-up. Typically, two antibiotics are prescribed, such as co-trimoxazole/clindamycin plus amoxicillin (amoxicillin-clavulanate) or cefdinir.
• Intravenous antibiotics: Required for children under 1 year old, those unable to take oral medication, or severe cases. Hospitalization is necessary, following treatment protocols for orbital cellulitis. After 3–5 days of improvement, IV antibiotics can be switched to oral ones. The full course lasts 2–3 weeks, or at least 4 weeks for severe cases.

Is hospitalization needed for periorbital cellulitis?

Hospitalization is required for infants under 1 year old, uncooperative pediatric patients, or severe cases, following orbital cellulitis treatment protocols. This ensures prompt management and monitoring to prevent serious complications.

What antibiotics are used for periorbital cellulitis?

Since causative bacteria are rarely identified, antibiotics are chosen empirically. Options include co-trimoxazole, clindamycin, amoxicillin-clavulanate, amoxicillin, cefdinir, and doxycycline. Doxycycline is not recommended for children due to risks to teeth and bone development.

Is follow-up necessary after periorbital cellulitis?

Recurrence is rare after cure, so routine follow-up isn’t typically scheduled. However, recurrent cases warrant investigation for underlying causes.

Can periorbital cellulitis be completely cured?

Yes, with prompt antibiotic treatment and infection control, it can be fully cured.

DIET & LIFESTYLE

What should patients with periorbital cellulitis pay attention to in their diet?

In terms of diet, choose nutrient-dense foods such as meat, fish, dairy products, vegetables, and fruits to aid recovery. If loss of appetite occurs due to severe systemic symptoms, eat smaller, more frequent meals rather than skipping food entirely.

What should patients with periorbital cellulitis pay attention to in daily life?

Maintain good hygiene by washing hands frequently, trimming nails, and avoiding scratching the eyes or face.

How should family members care for patients with periorbital cellulitis?

• Children with periorbital cellulitis may become irritable and cry due to eye swelling and pain, affecting normal eating and sleep. Caregivers should provide comfort and closely monitor their condition, as symptoms in children can worsen rapidly.
• If there is excessive eye discharge, gently remove it with sterile cotton swabs.
• Young children may resist taking medication, so parents should be patient. Using a medicine dispenser ensures accurate dosing.
• Similarly, adult patients may experience fear or anxiety due to eye symptoms. Family members should offer reassurance—full recovery is possible with proper treatment and care.

PREVENTION

Can periorbital cellulitis be prevented? How to prevent it?

• If you have severe sinusitis, seek medical attention to reduce the risk of developing periorbital cellulitis.
• Wash hands frequently, trim nails regularly, and avoid bites from animals and insects.

How can patients with periorbital cellulitis prevent other diseases?

Although the risk of complications from periorbital cellulitis is very low, active anti-infective treatment is still necessary to prevent bacterial spread. Maintain hand hygiene and ensure eye sterility as much as possible, which can further promote recovery and prevent complications.