eye disorders
Preseptal and Orbital Cellulitis
Diagnosis of Preseptal and Orbital Cellulitis
Mainly clinical evaluation CT or MRI if orbital cellulitis is possible Diagnosis of preseptal cellulitis and orbital cellulitis is primarily clinical. Other disorders to consider include trauma, insect or animal bites without cellulitis, retained foreign bodies, allergic reactions, tumors, and inflammatory orbital pseudotumor. Eyelid swelling may require the use of lid retractors for evaluation of the globe, and initial signs of complicated infection may be subtle. An ophthalmologist should be consulted when orbital cellulitis is suspected. Preseptal cellulitis and orbital cellulitis are often distinguishable clinically. Preseptal cellulitis is likely if eye findings are normal except for eyelid swelling. The presence of a local nidus of infection on the skin makes preseptal cellulitis even more likely. Suspect orbital cellulitis and consult an ophthalmologist if there is decreased ocular motility, pain with eye movements, proptosis, or decreased visual acuity. If findings are equivocal, if the examination is difficult (as in young children), or if nasal discharge is present (suggesting sinusitis), CT or MRI should be done to exclude orbital cellulitis, tumor, and pseudotumor. MRI is better than CT if cavernous sinus thrombosis is being considered. The direction of proptosis may be a clue to the site of infection; eg, extension from the frontal sinus pushes the globe down and out, and extension from the ethmoid sinus pushes the globe laterally and out. Blood cultures are often done (ideally before beginning antibiotics) in patients with orbital cellulitis, but less than one third are positive. Lumbar Puncture (Spinal Tap) is done if meningitis is suspected. Cultures of the paranasal sinus fluid are done if sinusitis is the suspected source. Other laboratory tests are not particularly helpful. 