Back to Basics: Periorbital Cellulitis versus Orbital Cellulitis

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September 3, 2015 by dailybolusoflr

By: Casey Carr, MD

Infections of the eye in the pediatric patient need quick and proper diagnosis as there is a potential for significant morbidity.  
Periorbital cellulitis is an infection of the eyelids and the orbital structures anterior to the orbital septum; orbital cellulitis is an infection of the structures posterior to the orbital septum but not involving the globe. 
Periorbital cellulitis and orbital cellulitis mostly occur in patients less than 5 years old and can have similar clinical presentations but entirely different management and prognosis. Both will present with unilateral eyelid erythema, swelling, warmth, and tenderness. However, some clinical features will raise the suspicion for orbital cellulitis.
Clinical Signs of Orbital Cellulitis
Decrease in visual acuity
Ophthalmoplegia
Proptosis
Chemosis
Painful eye movement
Increased intraorbital pressure
Abnormal pupillary response
References:
  1. Tintinalli’s Emergency Medicine, 7th edition
  2. Hauser, et al. “Periorbital and Orbital Cellulitis”. Pediatrics in Review. 2010 June;31(6):242-49

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