An infection in the eyelid tissues anterior to the orbital septum
Much more common and less serious than Orbital cellulitis
Causes/Factors
- Superficial injury (eg insect bite, chalazion, Conjunctivitis)
- Can be secondary to URTI or sinusitis
Clinical Features
Must exclude orbital cellulitis and red flag features
- Eyelid redness, mild tenderness and swelling
- Fever
- Systemically well, no pain on eye movement. No visual changes
| Peri-orbital cellulitis | Orbital cellulitis | |
|---|---|---|
| Proptosis | No | Yes |
| Eye movements | Normal | Painful/restricted |
| Visual acuity | Normal | May be reduced |
| Colour vision | Normal | May be reduced |
| RAPD (different light reflex) | No | Yes in severe cases |
Diagnostic Tests
There are no specific investigations but if there is any suspicion of Orbital cellulitis or unclear diagnosis, refer to secondary care for CT head
Management
Emergency referral to ophthalmology/ENT if:
- there is any suspicion of Orbital cellulitis
- the patient is systemically unwell
- the patient is a child as paediatric patients require empirical IV antibiotics and daily monitoring due to the difficulty in differentiating between the two - can be challenging history and exam to take
For adult patients oral Co-amoxiclav is 1st line (Clindamycin if pen allergic) Consider 24-48h follow up and safety netting advice should be given
Complications/red Flags
- Peri-Orbital cellulitis can spread to cause Orbital cellulitis. Important to provide adequate safety netting advice to patients