eye disorders
Preseptal and Orbital Cellulitis
Treatment of Preseptal and Orbital Cellulitis
Antibiotics In patients with preseptal cellulitis, initial therapy should be directed against sinusitis pathogens (S. pneumoniae, nontypeableH. influenzae,S. aureus,Moraxella catarrhalis); however, in areas where methicillin-resistantS. aureusis prevalent, clinicians should add appropriate antibiotics (eg,clindamycin,trimethoprim/sulfamethoxazole, ordoxycyclinefor oral treatment andvancomycinfor inpatient treatment). In patients with dirty wounds, gram-negative infection must be considered. Outpatient treatment is an option if orbital cellulitis has been definitively excluded; children should have no signs of systemic infection and should be in the care of responsible parents or guardians. Patients should be closely followed by an ophthalmologist. Outpatient treatment options includeamoxicillin/clavulanate 30 mg/kg orally every 8 hours (for children<12 years) or 500 mg orally every 8 to 12 hours or 875 mg orally 2 times a day (for adults) for 10 days. (Dose may need to increase if penicillin-resistantS. pneumoniaeis suspected.) For inpatients,ampicillin/sulbactam50 mg/kg IV every 6 hours (for children) or 1.5 to 3 g (for adults) IV every 6 hours (maximum 8 gampicillin/day) for 7 days is an option. If methicillin-resistantS. aureusis a consideration, antibiotics should be adjusted accordingly. Patients with orbital cellulitis should be hospitalized and treated with meningitis-dose antibiotics (see table). A 2nd- or 3rd-generation cephalosporin, such ascefotaxime50 mg/kg IV every 6 hours (for children<12 years) or 1 to 2 g IV every 6 hours (for adults) for 14 days, is an option when sinusitis is present; imipenem,ceftriaxone, andpiperacillin/tazobactamare other options. 1g IV once/day), and be taken for 7 to 10 days or until clinical improvement ( Treatment reference ). If anaerobic pathogens are suspected (as may be the case with dental infections),metronidazoleis typically used. Surgery to decompress the orbit, drain an abscess, open infected sinuses, or a combination is indicated in any of the following circumstances: Vision is compromised. Suppuration or foreign body is suspected. Imaging shows orbital or large subperiosteal abscess, particularly along the orbital roof. The infection does not resolve with antibiotics. 1.Liao JC, Harris GJ: Subperiosteal abscess of the orbit: Evolving pathogens and the therapeutic protocol.Ophthalmology122(3):639-647, 2015. doi: 10.1016/j.ophtha.2014.09.009 