From the Guidelines
The diagnostic approach for preseptal cellulitis should involve a thorough clinical evaluation combined with targeted investigations, including a comprehensive history and physical examination, laboratory tests, and imaging studies such as CT scan with contrast of the orbits when orbital involvement is suspected or in severe cases, as recommended by the most recent study 1. The diagnostic process begins with a comprehensive history and physical examination, focusing on symptoms like eyelid swelling, redness, pain, and fever. Visual acuity assessment and careful examination of ocular motility, pupillary reactions, and fundoscopy are essential to differentiate preseptal from orbital cellulitis. Some key points to consider in the diagnostic approach include:
- Laboratory tests including complete blood count, blood cultures (if systemic symptoms are present), and C-reactive protein can help assess infection severity.
- Imaging studies, specifically CT scan with contrast of the orbits, are not routinely required for uncomplicated preseptal cellulitis but should be performed when orbital involvement is suspected or in cases with severe presentation, immunocompromised status, or poor response to initial therapy, as supported by the study 1.
- Microbiological cultures from any drainage or associated wounds may help identify the causative organism. The primary goal is to accurately diagnose the condition while ruling out the more dangerous orbital cellulitis, which presents similarly but requires more aggressive management, and this approach is crucial because preseptal cellulitis, while typically less serious than orbital cellulitis, can progress to more severe complications if misdiagnosed or inadequately treated, as highlighted in the study 1.
From the Research
Diagnostic Approach for Preseptal Cellulitis
The diagnostic approach for preseptal cellulitis involves a combination of physical examination, medical history, and laboratory tests.
- A thorough physical examination can help differentiate preseptal cellulitis from other conditions, such as orbital cellulitis, by identifying signs of erythema, edema, and warmth 2.
- A complete medical history can help identify risk factors and potential sources of infection, such as sinusitis or trauma 2, 3.
- Laboratory tests, such as blood cultures and complete blood counts, may be ordered to help confirm the diagnosis and guide antibiotic treatment 4, 5.
- Imaging studies, such as CT or MRI scans, may be used in some cases to help differentiate preseptal cellulitis from orbital cellulitis or to identify potential complications 3, 5.
Key Diagnostic Features
- Erythema and edema of the eyelid and surrounding skin 2, 6
- Warmth and tenderness to the touch 6
- Poorly demarcated unilateral erythema 6
- Presence of risk factors, such as sinusitis or trauma 2, 3