In various studies, it has been shown that 85-95% of orbital infections due to sinusitis are preseptal cellulitis and 5-15% are postseptal infections (13).
Those patients with orbital cellulitis were found to have proptosis and ophthalmoplegia, and preseptal cellulitis was the most common presentation with redness and discharge.
Acyclovir was also added to the treatment due to preseptal cellulitis, which was caused by zona zoster (Figure 1).
Orbital and preseptal cellulitis: a 10-year survey of hospitalized patients in a tertiary eye hospital in Iran.
Although the most important risk factor for the development of orbital cellulitis is paranasal sinusitis, any infection including conjunctivitis, dacryoadenitis, and hordeolum or trauma in the eye and adjacent tissues may lead to preseptal cellulitis. In a study conducted by Ambati et al.
However, it is controversial to perform CT imaging for each child with a suspicion of preseptal cellulitis. Orbital assessment with CT should be performed in patients who have physical examination findings suggestive of orbital cellulitis including limitation in eye movements, pain, reduction in visual acuity, proptosis, and ophthalmoplegia, whose ophthalmologic examination cannot be performed efficiently because of young age and who do not respond to parenteral antibiotic treatment.
Although some authors argue that children older than one year who do not have toxic findings might be treated with oral antibiotics without hospitalization, all patients should be hospitalized and broad-spectrum parenteral antibiotic treatment directed to aerobic and anaerobic microorganisms should be initiated because it is difficult to clinically differentiate preseptal cellulitis from orbital cellulitis and because of potential complications (12, 23).
Preseptal cellulitis is much more common than orbital cellulitis in children.
If the eye has normal motility, no proptosis, and no pupillary signs and the child has normal vision, the diagnosis is preseptal cellulitis. "It may look terrible, but under the lid they see normally," Dr.
Preseptal cellulitis often can be treated on an outpatient basis with an oral antibiotic such as Augmentin, although more severely ill patients and very young children still require hospitalization and intravenous antibiotics.
Preseptal cellulitis is usually caused by contiguous spread of infection from local facial or eyelid injuries, insect bites, conjunctivitis and chalazion and rarely sinusitis.
Symptoms and signs of preseptal cellulitis include tenderness, swelling, warmth, redness or discolouration of the eyelid and sometimes fever.