What is the treatment for cellulitis on the eyelids?

Treatment of Eyelid Cellulitis

For cellulitis of the eyelids, treatment with a 5-7 day course of antibiotics targeting beta-hemolytic streptococci and Staphylococcus species is recommended, with extension of therapy if clinical improvement is not observed within this timeframe. 1

Classification of Periorbital Infections

It's important to distinguish between two types of eyelid infections:

1. Preseptal (periorbital) cellulitis: Infection limited to tissues anterior to the orbital septum
2. Orbital cellulitis: More serious infection involving the contents of the orbit behind the septum

Diagnostic Approach

• Assess for warning signs of orbital involvement:

  • Proptosis (eye displacement)
  • Pain with eye movements
  • Restriction of extraocular movements/diplopia
  • Vision changes
  • Severe eyelid swelling with pain and erythema 2

• If orbital involvement is suspected, urgent imaging (CT scan) and ophthalmology referral are required 3

Antibiotic Treatment

First-line therapy:

• Beta-lactam antibiotics targeting streptococci and staphylococci:
  • Cephalexin 500mg orally four times daily 1
  • Amoxicillin-clavulanate 1

Alternative options (especially for penicillin allergy):

• Clindamycin 600mg orally three times daily 1
• Doxycycline (not for children <8 years) 1

For severe cases requiring hospitalization:

• IV vancomycin (particularly for MRSA coverage) 1
• Alternative IV options:
  • Linezolid 600mg twice daily
  • Daptomycin 4mg/kg/day IV 1

Duration of Treatment

• Initial course of 5-7 days 1
• Reassess after 5 days and extend treatment until 2-3 days after clinical resolution if inadequate improvement is seen 1
• Daily follow-up is recommended until definite improvement is noted 1

Adjunctive Measures

• Warm compresses to the eyelids for several minutes to soften adherent discharge 2
• Gentle eyelid cleansing to remove crusting 2
• Elevation of the affected area to reduce edema 1

Special Considerations

• Obtain cultures from any purulent drainage to guide therapy 1
• Consider underlying sinusitis as a common predisposing factor, especially in orbital cellulitis (present in 79% of cases) 4
• Upper respiratory infections are common predisposing factors for periorbital cellulitis (68% of cases) 4
• Children under 5 years are more commonly affected by periorbital cellulitis, while orbital cellulitis is more common in children over 5 years 4

When to Refer

• Same-day ophthalmology referral for any signs of orbital involvement 2
• Surgical intervention may be necessary in approximately 6% of cases 4
• Consider otorhinolaryngology consultation when sinusitis is the underlying cause and not responding to first-line treatment 5

Complications to Monitor

• Orbital cellulitis can lead to vision loss and potentially life-threatening intracranial complications if not properly treated 3
• Endophthalmitis is a rare but serious complication 2

Early recognition and appropriate antibiotic therapy are essential to prevent serious complications from eyelid cellulitis.