Eye cellulitis

Other terms

• Preseptal cellulitis
• Periorbital cellulitis
• Orbital cellulitis
• Retroseptal cellulitis

Definition

Cellulitis is inflammation of the skin and soft tissues. There are two types of ocular cellulitis, classified according to the tissue affected:

• Preseptal cellulitis is generally secondary to a wound close to the eye, such as an insect bite, animal bite, chalazion or sinusitis.
• Retroseptal (or orbital) cellulitis, which affects the deep tissues of the orbit.

Orbital cellulitis is an ophthalmological emergency, as it can lead to blindness and brain damage.

Causes

Cellulitis is caused by a bacterial infection that has spread to the tissues of the eye socket.

• Preseptal cellulitis is generally secondary to a wound close to the eye, insect bite, animal bite, chalazion or sinusitis.
• Orbital cellulitis is generally secondary to the extension of an adjacent sinus infection.

The bacterial strains most frequently implicated are :

• Streptococcus pneumoniae
• Staphylococcus aureus
• Streptococcus pyogenes
• Haemophilus influenzae type b (Hib)

Cellulitis is generally not contagious.

Symptoms

Symptoms of preseptal cellulitis include:

• Pain
• Redness and warmth of the eyelid
• swelling of the eyelid

Visual acuity is not affected.

Symptoms of orbital cellulitis include :

• swelling and redness of the tissues around the eye
• A red, bulging eye
• Diminished ocular motricity
• Decreased visual acuity
• exophthalmos due to ocular swelling
• fever
• runny nose with sinusitis
• Headache (suspicion of associated meningitis)

Diagnostic

Diagnosis is made following a clinical examination. Additional tests may be required (blood tests, CT scan, bacteriological culture).

Symptoms of orbital cellulitis, especially in children, must be promptly reported to the emergency room, as complications can be serious.

Treatments

Preseptal cellulitis requires treatment with oral antibiotics for 10 days.

Orbital cellulitis generally requires hospitalization with intravenous antibiotic therapy.

Surgery (decompression surgery, abscess drainage, opening of an infected sinus) may also be necessary in the following cases:

• infection does not improve despite antibiotic therapy
• When vision is compromised
• In the presence of a foreign body or orbital abscess

Frequency

Preseptal cellulitis is common, particularly in children.

Orbital cellulitis is a rare complication, affecting around 1 in 100,000 children.

Prevention

A few preventive measures can be taken:

• Facial wounds should be carefully cleaned and disinfected.
• In the event of sinusitis, appropriate treatment should be instituted.
• Children should be vaccinated against Hib before the age of 5.

References

Cellulite oculaire - Infection de la paupière et de l'orbite (centreophta.com)

Cellulite préseptale et orbitaire - Troubles oculaires - Édition professionnelle du Manuel MSD (msdmanuals.com)

Murphy C. et al. Orbital cellulitis in Scotland: current incidence, aetiology, management and outcomes. British Journal of Ophthalmology 2014; 98:1575-1578.

Source : EM Consulte