Continuing Education Activity

Periorbital cellulitis, or preseptal cellulitis, is a skin and soft tissue infection surrounding the eye, located anterior to the orbital septum. Although serious complications from periorbital cellulitis are uncommon, it is sometimes misdiagnosed as the more severe condition, orbital cellulitis. Periorbital cellulitis is most common in children aged 5 or younger and is typically caused by trauma, insect bites, or contiguous dissemination from neighboring structures, as in the case of sinusitis. Patients usually present with unilateral eyelid erythema, edema, and soreness, with preserved visual acuity and extraocular movements. In contrast, patients with orbital cellulitis present with similar findings along with additional ocular symptoms, including proptosis, eye pain, decreased vision, and restricted extraocular motility.

Diagnosis involves clinical evaluation, with imaging tests, particularly contrast-enhanced computed tomography of the orbits and sinuses or magnetic resonance imaging, which are valuable for differentiating periorbital cellulitis from orbital cellulitis and other complications. Treatment includes antibiotics targeting Staphylococcus aureus and Streptococcus species, with adjustments for methicillin-resistant S aureus in relevant regions. Patients with more severe disease or children aged 1 or younger should be hospitalized. This activity reviews the evaluation and treatment of periorbital cellulitis, focusing on the critical role of an interprofessional healthcare team in the management of periorbital cellulitis. This activity also emphasizes the importance of prompt recognition and effective intervention to prevent complications.

Objectives:

• Identify the clinical signs and symptoms of periorbital cellulitis, including eyelid erythema, edema, and preserved visual acuity.
• Implement evidence-based diagnostic protocols, including clinical evaluation and appropriate imaging when necessary, to confirm the diagnosis of periorbital cellulitis.
• Select the most suitable imaging modalities, such as contrast-enhanced CT or MRI, to aid in distinguishing periorbital cellulitis from orbital cellulitis.
• Collaborate with ophthalmologists, infectious disease specialists, and other healthcare providers to ensure comprehensive care and management of periorbital cellulitis.

Introduction

Periorbital cellulitis, also known as preseptal cellulitis, is an acute infection affecting the eyelid and periorbital soft tissues located anterior to the orbital septum.[1][2] This condition must be distinguished from orbital cellulitis, which involves infection of the orbital tissues located posterior to the orbital septum.[3] The orbital septum, a thin fibrous membrane originating from the periosteum of the orbital rims, acts as an anatomical barrier that prevents the spread of infection between superficial and deeper ocular tissues. Infections located anterior to the septum, such as periorbital cellulitis, are clinically significant because they may progress to more serious orbital or systemic complications if left untreated.[4] Please see StatPearls' companion resource, "Ocular Cellulitis," for more information.

The dissemination of infections in the periorbital tissues is influenced by facial structure, including lymphatic drainage and venous linkages. Despite the protective role of the orbital septum, there is still a risk of infection that can spread from the eyelid to deeper regions, particularly in cases of delayed or inadequate treatment. This underscores the importance of prompt assessment and targeted therapy to prevent complications.

Periorbital cellulitis can manifest at any age, but it is more prevalent in children aged 5 or younger.[5] The condition usually arises from localized trauma, insect bites, or contiguous dissemination from neighboring structures, such as the paranasal sinuses.[4] The condition typically presents with a sudden onset of erythema, edema, and soreness around the eye, while visual acuity and extraocular movements are preserved. Effective management requires prompt identification, accurate differentiation from orbital cellulitis, and appropriate antibiotic treatment. Although orbital cellulitis may present with similar symptoms, it is characterized by additional ocular signs, such as proptosis, eye pain, decreased vision, and limited extraocular motility.

Patients with orbital cellulitis can present with similar findings, but they often exhibit additional ocular symptoms such as proptosis, eye pain, decreased vision, and limited extraocular motility. Distinguishing between periorbital cellulitis and orbital cellulitis is crucial, as treatment and management vary based on the diagnosis. The treatment for periorbital cellulitis typically includes antibiotics targeting the most commonly isolated bacteria, such as Staphylococcus aureus and Streptococcus species. Most cases resolve within 5 to 7 days with appropriate antibiotic therapy. However, cases that show resistance to treatment or progress with severe symptoms should be further evaluated for complications, including orbital cellulitis and other potential underlying conditions.

Etiology

Periorbital cellulitis has various etiologies, typically categorized as traumatic, contiguous, or hematogenous in origin. Local trauma, including minor lacerations, abrasions, or insect bites near the eyelid, is among the most common causes, as these breaches in the skin's barrier facilitate bacterial entry. Infections can also spread from adjacent anatomical regions, particularly the paranasal sinuses. Due to its proximity to the orbital structures, ethmoid sinusitis is a common cause of periorbital cellulitis. Pathogens can spread through venous connections or via abnormalities in the bone septa separating the sinuses from the orbital area. Although rare, hematogenous dissemination can occur in cases of bacteremia or systemic infections, particularly in immunocompromised individuals or pediatric patients. In some instances, pathogens may invade the periorbital tissues through the bloodstream. This condition commonly arises from the spread of infection, rhinosinusitis, or local trauma.[6]

Understanding the anatomy of the orbit and its surrounding structures is crucial to comprehending the pathways and causes of periorbital cellulitis.[7] The orbit is lined by periosteum and is surrounded by paranasal sinuses—the frontal sinus superiorly, the ethmoid sinus medially, and the maxillary sinus inferiorly. Acute ethmoiditis is the most common type of rhinosinusitis associated with periorbital and orbital cellulitis.[8] Infections originating from the ethmoid sinus can progress rapidly due to the lamina papyracea—a thin bony structure that serves as the primary barrier between the ethmoid sinus and the orbit.[9] This lamina contains perforations and fenestrations, known as Zuckerkandl dehiscence, which allow the passage of nerves and blood vessels, facilitating the spread of infection from the ethmoid sinuses to the periorbital and orbital regions.[10][11]

The orbital septum is a membranous structure that originates from the lining of the orbital periosteum.[12] This boundary determines whether an infection is classified as periorbital (preseptal) or orbital (postseptal). Preseptal infections are rarely associated with serious complications, although they can sometimes progress to orbital cellulitis.[13] Misdiagnosing orbital cellulitis as periorbital cellulitis is a common issue, often resulting in inadequate treatment. The orbital septum serves as a crucial anatomical barrier. However, periorbital infections can spread through the valveless facial venous system, facilitating posterior extension into the orbits and beyond. Additionally, the superior and ophthalmic veins directly drain into the cavernous sinus, creating a pathway for the infection to reach intracranial structures. Without adequate or prompt treatment, periorbital and orbital cellulitis can progress, potentially causing severe ophthalmic complications, including vision impairment, blindness, and intracranial involvement.

The primary causes of periorbital cellulitis are bacterial pathogens.[14][15] In pediatric patients, S pneumoniae and S aureus are the most common aerobic bacteria, with methicillin-resistant S aureus (MRSA) becoming increasingly significant.[16] Haemophilus influenzae type B (Hib) was once a leading cause of periorbital cellulitis in young children. However, the introduction of the Hib vaccine has significantly reduced its prevalence.[17][18] In immunocompromised patients, fungal and atypical pathogens should also be considered as part of the differential diagnosis.[19]

Epidemiology

Periorbital cellulitis can occur at any age but is particularly common in the pediatric population. This condition is more frequent than orbital cellulitis. Studies have shown that periorbital cellulitis primarily affects children aged 5 or younger.[20] Observational studies based on pediatric emergency departments reveal that children with orbital cellulitis are generally older, often present with fever, and have a history of preexisting sinusitis, in contrast to those diagnosed with periorbital cellulitis.[21] Symptoms such as diplopia, proptosis, and ocular pain with movement are key in differentiating orbital cellulitis from periorbital cellulitis.

In the United States, the prevalence of periorbital cellulitis has decreased significantly due to widespread vaccination against Hib. However, it remains a common reason for pediatric emergency department visits.[22] The global epidemiology of periorbital cellulitis varies depending on vaccination rates and the incidence of conditions such as sinusitis or skin infections. In regions with lower immunization rates, Hib continues to be a prominent pathogen.[23] Seasonal fluctuations are observed, with increased frequency during the winter months, coinciding with a rise in upper respiratory tract infections and sinusitis. Periorbital cellulitis affects all racial and ethnic groups without significant distinction. Socioeconomic factors, including healthcare access and immunization rates, can influence the prevalence and outcomes of periorbital cellulitis in different populations.

Pathophysiology

The pathogenesis of periorbital cellulitis involves bacterial infiltration of the periorbital soft tissues, resulting in inflammation and edema. The infection remains confined to the structures located anterior to the orbital septum, including the eyelids, subcutaneous tissue, and associated musculature.[14] Typical observations include an initial inflammatory response characterized by erythema, edema, increased warmth, and discomfort. In cases of sinusitis, bacterial invasion of the sinus walls can lead to the spread of infection into surrounding tissues. Traumatic disruptions in the skin barrier also allow microorganisms to enter, resulting in localized infection.

The most common bacterial causes of periorbital cellulitis include S aureus, Streptococcus pneumoniae, and S pyogenes.[24][25] With the widespread use of vaccination, the incidence of H influenzae as a causative organism has decreased. However, there has been a rise in cases of MRSA causing periorbital cellulitis. However, there has been a rise in instances of MRSA causing periorbital cellulitis.[26] Less common pathogens include Acinetobacter, Nocardia, Bacillus, Pseudomonas, Neisseria, Proteus, Pasteurella, and Mycobacterium.[27][28] Although rare, fungal infections, particularly from Mucorales and Aspergillus, have also been documented as causes of periorbital and orbital cellulitis.[29]

The most common inciting events for periorbital cellulitis include sinusitis, hematogenous seeding, and direct skin inoculation, such as through insect bites, periocular or facial trauma, and impetigo. Pathogens causing sinusitis, particularly ethmoiditis, spread to nearby tissues via the valveless ophthalmic venous system or the lamina papyracea. In fact, the most common complications of sinusitis are periorbital or orbital involvement and intracranial extension.

Despite its superficial appearance, delayed or inadequate treatment of periorbital cellulitis can lead to serious complications, such as the spread of infection into the orbit, resulting in orbital cellulitis.[3] Bacteremia or septicemia may also develop, particularly in children or immunocompromised adults. Periorbital cellulitis can progress to orbital cellulitis and vision loss without prompt treatment. In severe cases, it can extend further to cause a subperiosteal abscess, orbital abscess, cavernous sinus thrombosis,[30] or intracranial infections, including intracerebral abscess,[31] meningitis, and empyema or abscess of the epidural or subdural space.

Histopathology

Histopathological analysis of periorbital cellulitis typically reveals acute inflammatory changes in the affected tissues. Differentiating between periorbital and orbital cellulitis, or a combination of both, can sometimes be challenging.[32] These changes include edema, vascular congestion, and neutrophilic infiltration, indicative of an acute bacterial infection. In cases of severe or prolonged infection, tissue necrosis may be observed. A biopsy, along with Gram staining and culture, can help identify the causative organism. In rare cases, particularly in immunocompromised individuals, fungal elements such as hyphae may be present, necessitating antifungal treatment.[33]

History and Physical

The clinical presentation of periorbital cellulitis often includes a history of preceding trauma, insect bites, or upper respiratory infections.[5] Patients may exhibit erythema, edema, and soreness surrounding the affected eye, with symptoms typically manifesting swiftly over hours to days.[3] Key features to assess include ophthalmic complaints, fever, and swelling. Periorbital and orbital cellulitis share overlapping symptoms, which can complicate diagnosis in certain cases (see Image. Stye With Periorbital Cellulitis).

Periorbital cellulitis typically presents with erythema, edema, and swelling localized to the eyelid. Symptoms are usually unilateral. Vision, globe motility, and intraocular pressure remain unaffected because the infection and inflammation are confined to the superficial, anterior periocular tissues, without involving the extraocular muscles. In contrast, orbital cellulitis arises from a deeper infection posterior to the orbital septum, leading to symptoms such as proptosis, restricted extraocular movement, ophthalmoplegia, and impaired vision, along with eyelid erythema and edema.

The absence of fever often suggests a preseptal infection; however, some cases of orbital cellulitis may also present without fever. Conversely, periorbital cellulitis can sometimes be associated with fever, conjunctival injection, chemosis, tearing, discharge, and mild vision reduction, complicating differentiation from orbital cellulitis. Systemic symptoms such as fever or malaise are uncommon but may occur in cases involving bacteremia or severe localized infection. Accurate differentiation is critical, as periorbital cellulitis may resemble conditions such as allergic reactions, trauma without cellulitis, orbital tumors, acute lymphoblastic leukemia,[25] demodicosis,[34] dysthyroid exophthalmos,[35] chalazion, or hordeolum.[36] Some of these conditions can progress to or present alongside periorbital cellulitis.

Inadequate treatment of periorbital cellulitis can result in complications such as orbital cellulitis, subperiosteal abscess, orbital abscess, or cavernous sinus thrombosis, as categorized in the Chandler classification of orbital complications.[37][38]

• Group 1—Preseptal cellulitis: This condition involves inflammation and edema confined to the soft tissues of the eyelid and other superficial structures.
• Group 2—Orbital cellulitis: This condition refers to bacterial infection within the orbit, leading to inflammation of the periorbital and orbital adipose tissues. This condition may manifest as impaired vision, ophthalmoplegia, pain with eye movement, chemosis, conjunctival injection, proptosis, fever, and leukocytosis.[39]
• Group 3—Subperiosteal abscess: This condition is characterized by the collection of pus between the orbital wall and surrounding periorbital structures, often causing displacement of the globe laterally or downward.[37] Patients may experience limited eye movement and present with proptosis. This abscess can rupture through the orbital septum, either manifesting in the eyelids or rupturing posteriorly into the orbital space to form a true orbital abscess, which is classified as group 4.
• Group 4—Orbital abscesses: This is a localized collection of pus within the orbital tissue, resulting in exophthalmos, chemosis, significant vision impairment, and ophthalmoplegia. The abscess may also extend anteriorly and rupture into the eyelids.
• Group 5—Cavernous sinus thrombosis: This results from the progression of infection into the cavernous sinuses, often causing symptoms in the contralateral eye. In severe cases, patients may develop meningitis. Although not always a strict continuum, the conditions within this classification system share overlapping presentations and should be carefully considered when evaluating a patient with ophthalmic complaints.[40]

Evaluation

A precise diagnosis of periorbital cellulitis requires a thorough clinical examination and detailed patient history, which may be supplemented with diagnostic testing.[41] Blood cultures are not routinely performed, as they are challenging to obtain in patients with periorbital cellulitis and are almost always negative. However, laboratory analyses such as a complete blood count (CBC) may reveal leukocytosis in bacterial infections. Blood cultures are recommended for patients with fever or systemic illness to identify potential bacteremia.[42]

Although the diagnosis of periorbital cellulitis is primarily based on clinical signs and symptoms, radiological findings may be necessary in some cases, particularly when the distinction between periorbital and orbital cellulitis is unclear. Imaging tests, such as contrast-enhanced computed tomography (CT) [43] of the orbits and sinuses and magnetic resonance imaging (MRI),[44] are useful for distinguishing periorbital cellulitis from orbital cellulitis or other sequelae.[41] CT findings indicative of periorbital cellulitis include soft tissue thickening and edema confined to the area anterior to the orbital septum, without evidence of posterior involvement or abscess formation. When an abscess is suspected, a CT scan of the head may be necessary to exclude intracranial involvement.[45] A CT scan is also recommended in cases of significant eyelid swelling, fever, leukocytosis, or lack of improvement within 24 hours of appropriate antibiotic treatment.[46][47]

Treatment / Management

The treatment of periorbital cellulitis depends on the severity of the condition and the patient's age. The primary approach is typically antibiotic therapy targeting S aureus, Streptococcus species, and anaerobes. For patients aged 1 or older with mild symptoms, outpatient treatment with topical and/or oral antibiotics is appropriate.[48] However, patients with more severe diseases or who are younger than 1 year should be hospitalized for closer monitoring and intravenous antibiotic therapy.[49]

Prior treatments for periorbital cellulitis included amoxicillin-clavulanic acid, cefpodoxime, or cefdinir.[20][50] For MRSA coverage,[51] particularly in regions with high MRSA prevalence, recommended antibiotics include trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin, or doxycycline. However, TMP-SMX and doxycycline lack coverage for group A Streptococcus, and doxycycline is unsuitable for children aged 8 or younger. Current guidelines suggest using clindamycin or TMP-SMX in combination with amoxicillin-clavulanic acid, cefpodoxime, or cefdinir. For unimmunized patients against H influenzae, a beta-lactam antibiotic is advised. The typical antibiotic course lasts 5 to 7 days but may be extended if cellulitis persists.

Response to antibiotics is typically rapid and complete. However, if outpatient therapy fails to show improvement within 24 to 48 hours, hospitalization should be considered. This includes initiating broad-spectrum antibiotics, obtaining a CT scan, and consulting a surgeon for potential incision and drainage.[36][45] Intravenous antibiotics are essential for severe cases, immunocompromised patients, or those with significant systemic symptoms.[52] Empiric therapies often include ceftriaxone or vancomycin while awaiting culture results. No studies have demonstrated an association between steroid use and recurrence or complications of orbital cellulitis; therefore, steroids are not routinely prescribed.

Surgical intervention is rarely necessary but may be indicated in cases of abscess formation or probable advancement to orbital cellulitis.[53] Continuous monitoring of clinical response is essential, with follow-up imaging recommended if no improvement is observed within 48 to 72 hours. Surgery may be necessary for drainage for patients in groups 3, 4, or 5 of the Chandler classification. If there is uncertainty about whether the patient has periorbital or orbital cellulitis, even with a CT scan, it is recommended to treat it as orbital cellulitis.[54][55]

Differential Diagnosis

Conditions that resemble periorbital cellulitis should be carefully evaluated to avoid misdiagnosis. Orbital cellulitis is the primary differential diagnosis, presenting with proptosis, ophthalmoplegia, and pain during eye movement. Additional conditions to consider in the differential diagnosis include allergic contact dermatitis, which presents with non-infectious periorbital edema and pruritus; herpes zoster ophthalmicus, typically characterized by vesicular lesions along the trigeminal dermatome; chalazion and hordeolum, both of which cause localized eyelid edema; and superior vena cava syndrome, which is often associated with bilateral periorbital edema.

The following conditions should be considered in the differential diagnosis of periorbital cellulitis:

• Orbital cellulitis [5]
• Angioedema [56]
• Insect bites [57]
• Herpes zoster ophthalmicus [58]
• Cavernous sinus thrombosis [59]
• Chalazion [60]
• Internal and external hordeola [61]
• Mucormycosis [62]
• Nephrotic syndrome [63]
• Pott puffy tumour [64]
• Periorbital necrotizing fasciitis [49]
• Acute lymphoblastic leukemia [25]
• Demodicosis [34]
• Lepromatous leprosy [65]
• Carotid cavernous fistula [66][67]
• Orbital pseudotumor [68]
• Wells syndrome [69]
• Sebaceous carcinoma [70]
• Sphenoid wing meningioma [71]
• Retinoblastoma [72]
• Palpebral anthrax [73]

Staging

The Chandler classification of orbital complications categorizes these complications based on severity to guide appropriate treatment decisions.[74] Although this classification does not represent a true continuum of disease, it is crucial to consider these groups due to their similar presentations. The groups include:

• Group 1: Preseptal cellulitis
• Group 2: Orbital cellulitis
• Group 3: Subperiosteal abscess
• Group 4: Orbital abscess
• Group 5: Cavernous sinus thrombosis

Prognosis

The prognosis of periorbital cellulitis (or preseptal cellulitis) is generally favorable when identified and treated promptly. This superficial infection of the eyelid and surrounding tissues anterior to the orbital septum typically resolves with conservative medical treatment. The prognosis primarily depends on the timeliness of intervention, the presence of comorbidities, and the underlying etiological agent. In cases caused by prevalent bacteria such as S aureus (including methicillin-resistant variants) or S pneumoniae, prompt antibiotic treatment—administered orally or intravenously depending on severity—can lead to complete recovery without lasting sequelae.[75] Patients of younger age, particularly those aged 5 or younger, necessitate close monitoring due to the risk of disease progression and potential association with bacteremia.

Although complications are rare in cases of isolated periorbital cellulitis, they can arise if the condition is inadequately managed or misdiagnosed. Insufficient therapy may lead to the advancement of orbital cellulitis—a more severe infection involving the post-septal tissues. This progression increases the risk of severe outcomes, including abscess formation,[76] ocular necrotizing fasciitis,[77] vision impairment, or intracranial dissemination,[78] such as cavernous sinus thrombosis or meningitis. Diagnostic imaging, especially contrast-enhanced CT, is essential when orbital involvement is suspected to differentiate these conditions. Delayed treatment, especially in immunocompromised patients or those with poorly controlled diabetes, can heighten morbidity and complicate recovery.

Ocular necrotizing fasciitis is typically unilateral and often arises from preexisting preseptal cellulitis.[79] This condition may occur following ocular surgery or periorbital trauma, particularly in patients with underlying systemic conditions.[80] Clinical presentation commonly includes lid margin crusting, inflammation, discharge, and keratoconjunctivitis. Prompt treatment with intravenous antibiotics and surgical debridement is essential to manage this severe condition effectively.The long-term prognosis for periorbital cellulitis is typically favorable, with a low risk of recurrence when the underlying cause, such as sinus infection or localized trauma, is effectively managed. Residual cosmetic complications, such as eyelid scarring, are infrequent. Prompt treatment of sinusitis and careful hygiene for facial injuries significantly reduce the risk of recurrence. In developed regions with access to timely medical care, the prognosis is highly favorable, highlighting the importance of early detection and appropriate antimicrobial therapy.

Complications

Periorbital cellulitis, although typically a localized and manageable condition, can lead to serious complications if inadequately treated. The most concerning progression involves the spread of infection beyond the orbital septum, resulting in orbital cellulitis. This more severe condition affects the deeper orbital tissues and may manifest as proptosis, ophthalmoplegia, and visual disturbances, necessitating urgent intervention. Orbital cellulitis carries the risk of abscess formation within the orbital cavity (orbital abscess) or the adjacent subperiosteal space. These abscesses can exert pressure on the optic nerve, potentially causing vision loss if not promptly managed.Additional complications can arise from hematogenous or contiguous spread of the infection to cerebral tissues. Cavernous sinus thrombosis, a severe condition, may occur when the infection travels through valveless facial veins. This complication is characterized by severe headache, fever, cranial nerve deficits, and systemic indications of sepsis. Meningitis and brain abscesses are also potential outcomes, particularly in cases associated with sinusitis, as the infection can breach the thin bony barriers of the orbital and sinus cavities. Intracranial complications carry a substantial risk of morbidity and mortality, requiring prompt and rigorous medical and surgical intervention.Additional complications include the development of necrotizing fasciitis, a severe soft-tissue infection that can spread to surrounding facial or periorbital tissues. Untreated or inadequately managed periorbital cellulitis may infrequently lead to lasting consequences, including eyelid scarring or ptosis. Individuals with impaired immune systems, such as those with diabetes or undergoing immunosuppressive therapy, are especially susceptible to these complications. Vigilant monitoring, timely imaging, and proactive escalation of treatment are crucial for mitigating these risks and ensuring optimal patient outcomes.

Deterrence and Patient Education

Prevention of periorbital cellulitis requires addressing modifiable risk factors, such as timely treatment of sinus infections and proper wound care for facial injuries. Immunization against Hib and S pneumoniae significantly reduces its prevalence in pediatric populations. Educating patients and caregivers on recognizing early signs of periorbital cellulitis and the importance of prompt medical attention is vital. Following prescribed antibiotic regimens is essential to prevent recurrence or complications.

Pearls and Other Issues

Effective management of periorbital cellulitis relies on timely identification, appropriate intervention, and careful attention to key clinical factors. An important consideration is distinguishing periorbital cellulitis from orbital cellulitis, as the latter requires more aggressive treatment and carries a higher risk of complications. Clinicians must maintain a high level of suspicion for orbital involvement when symptoms such as proptosis, restricted ocular mobility, or significant pain during eye movement are present. Imaging studies, particularly contrast-enhanced CT, are crucial for differentiating these conditions and ensuring an accurate diagnosis.The management of periorbital cellulitis varies based on age, severity, and underlying conditions. Most adult patients with mild-to-moderate infections can be treated outpatient with oral antibiotics, provided there are no signs of systemic illness or orbital involvement. In contrast, young children, particularly those aged 5 or younger, and individuals with systemic symptoms or significant swelling may require hospitalization and intravenous antibiotics. Timely follow-up is essential to evaluate the effectiveness of treatment and promptly address any complications that may arise.Preventing periorbital cellulitis entails mitigating risk factors such as treating sinus infections, avoiding facial trauma, and managing local dermatological conditions such as dermatitis or insect bites. Common management pitfalls include delayed diagnosis, inadequate antibiotic coverage, and failure to recognize early signs of ocular or systemic involvement, which can lead to avoidable consequences. Awareness of resistant pathogens, such as MRSA, is vital for guiding empirical therapy, particularly in areas where these strains are prevalent. A proactive, thorough approach to evaluation and care significantly improves patient outcomes and reduces the risk of adverse consequences.

Enhancing Healthcare Team Outcomes

When a patient presents with an eye infection, it is essential for the emergency department physician, primary care provider, and nurse practitioner to promptly refer the patient to an ophthalmologist. The treatment of periorbital cellulitis varies based on disease severity and patient age. The mainstay of treatment typically involves antibiotic coverage targeting S aureus, Streptococcus species, and anaerobes. Patients aged 1 or older with mild symptoms can generally be treated as outpatients with oral antibiotics. However, those with more severe disease or aged 1 or younger should be hospitalized for intravenous antibiotics and closer monitoring.

The reaction to antibiotics in cases of periorbital cellulitis is typically rapid and effective. If there is no improvement with outpatient therapy within 24 to 48 hours, hospitalization is recommended. Treatment in these cases should include broad-spectrum antibiotics, along with further evaluation through a CT scan and possible surgical consultation for incision and drainage. Surgical intervention for drainage is necessary for patients classified in groups 3, 4, or 5 of the Chandler classification. When the differentiation between periorbital and orbital cellulitis is ambiguous, even after a CT scan, it is advisable to treat the condition as orbital cellulitis to avoid complications. Most patients who receive prompt and appropriate treatment experience positive outcomes. However, delayed treatment or severe infections may result in irreversible vision impairment, even with recuperation.[81]

The effective management of periorbital cellulitis requires a collaborative approach among general care physicians, emergency physicians, ophthalmologists, infectious disease specialists, and radiologists. Efficient communication and coordination are essential for prompt diagnosis, appropriate therapy, and ongoing monitoring. Nurses play a vital role in patient education, encouraging adherence to treatment protocols, and identifying early signs of complications. Pharmacists contribute by optimizing antibiotic regimens by considering local resistance patterns and patient-specific factors. Interprofessional collaboration among healthcare providers enhances patient-centered care, improves safety, and reduces the risk of complications, ultimately leading to favorable outcomes in the treatment of periorbital cellulitis.

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Disclosure: Marco Zeppieri declares no relevant financial relationships with ineligible companies.

Disclosure: Daniele Bourget declares no relevant financial relationships with ineligible companies.