Preseptal and Orbital Cellulitis
Description Diagnostic criteria Medicine treatment Referral ICD-10 code: H05.019/H05.012 DESCRIPTION Preseptal cellulitis (cellulitis of the tissues anterior to the orbital septum) is generally a mild condition that rarely leads to serious complications, whereas orbital cellulitis (involving the tissues posterior to the orbital septum, including the fat and muscle within the bony orbit) may cause
Description
Diagnostic criteria
Medicine treatment
Referral
ICD-10 code: H05.019/H05.012
DESCRIPTION
Preseptal cellulitis (cellulitis of the tissues anterior to the orbital septum) is generally a mild condition that rarely leads to serious complications, whereas orbital cellulitis (involving the tissues posterior to the orbital septum, including the fat and muscle within the bony orbit) may cause loss of vision and even loss of life.
DIAGNOSTIC CRITERIA
Patients with local tenderness (lid erythema/oedema only) and a normal eye examination can be treated for preseptal cellulitis with oral antibiotics.
However, care should be taken to identify those at risk of orbital cellulitis, who require admission and intravenous antibiotics. CT scan is warranted in patients with central signs (drowsiness, vomiting, headache, seizures or cranial nerve lesions), where vision cannot be accurately assessed, gross proptosis, ophthalmoplegia, deteriorating visual acuity or colour vision, bilateral oedema, no improvement or deterioration at 24 hours, or a swinging pyrexia not resolving within 36 hours.
MEDICINE TREATMENT
Initial management:
- Ceftriaxone, IV, 50 mg/kg once daily.
OR
If one month old or younger:
- Cefotaxime, IV, 50 mg/kg/dose 6–8 hourly.
If the diagnosis of preseptal cellulitis is confirmed, switch to:
- Amoxicillin/clavulanic acid, oral, 45 mg/kg/dose of amoxicillin component, 12 hourly (amoxicillin/clavulanic acid in a ratio of 14:1).
- Maximum dose of amoxicillin component: 1.5 g 12 hourly. (See annexure 1: Amoxicillin/Clavulanic weight band dosing table)
If the diagnosis of orbital cellulitis is confirmed, continue on intravenous antibiotics.
REFERRAL
- Patients with central signs.
- Patients where vision cannot be accurately assessed.
- Patients with gross proptosis, ophthalmoplegia, deteriorating visual acuity or colour vision.
- Patients with bilateral oedema.
- No improvement or deterioration after 24 hours of therapy.
- Swinging pyrexia not resolving within 36 hours.
- Orbital cellulitis secondary to chronic sinusitis (may be at risk of multiple abscesses).
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 16: Eye Conditions, 16.13 Preseptal And Orbital Cellulitis