From the Guidelines
Periorbital cellulitis should be treated with antibiotics targeting common causative organisms like Staphylococcus aureus, Streptococcus species, and Haemophilus influenzae, with a recommended duration of antimicrobial therapy of 5 days, but treatment should be extended if the infection has not improved within this time period 1.
Diagnosis and Treatment
Periorbital cellulitis is a serious bacterial infection affecting the eyelid and surrounding tissues anterior to the orbital septum. Immediate medical attention is required as it can progress to orbital cellulitis and potentially threaten vision or spread to the brain.
Key Considerations
- The infection commonly results from local trauma, insect bites, or spread from sinusitis 1.
- Patients should watch for worsening symptoms including eye pain, vision changes, difficulty moving the eye, or protruding eyeball, which suggest progression to orbital cellulitis requiring immediate medical evaluation.
- For mild cases in adults, oral antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) or clindamycin (300-450 mg four times daily for 7-10 days) if penicillin-allergic may be sufficient 1.
- Children and severe cases often require hospitalization for intravenous antibiotics like ceftriaxone (50-75 mg/kg/day) plus vancomycin (15 mg/kg every 6 hours) 1.
Management
- Warm compresses can help with comfort while antibiotics take effect.
- Complete the full antibiotic course even if symptoms improve quickly to prevent recurrence or antibiotic resistance.
- Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended 1.
- Outpatient therapy is recommended for patients who do not have SIRS, altered mental status, or hemodynamic instability, while hospitalization is recommended if there is concern for a deeper or necrotizing infection, for patients with poor adherence to therapy, or for infection in a severely immunocompromised patient 1.
From the Research
Diagnosis of Periorbital Cellulitis
- Periorbital cellulitis is often difficult to distinguish from orbital cellulitis, which is a potentially lethal infection involving the contents of the orbit 2
- The most common predisposing factors in periorbital cellulitis are upper respiratory infection (68%) and trauma to the eyelids (20%) 2
- Sinusitis is more frequently associated with orbital cellulitis (79%) 2
- Blood and skin cultures are usually negative, but the most common isolated pathogens are Staphylococcus aureus, Streptococcus pneumoniae, and Staphylococcus epidermidis 2
Treatment of Periorbital Cellulitis
- Antibiotic combinations such as penicillin plus chloramphenicol and sulbactam-ampicillin (SAM) with or without ornidazole can be used to treat periorbital cellulitis 3
- SAM can be the first line of drug treatment for periorbital cellulitis as it is easily used in every age group and etiology (trauma, sinusitis, etc.) and provides total recovery with less side effects and risk of recurrence 3
- Intravenous ceftriaxone + clindamycin can be an effective management for periorbital cellulitis, with a mean duration of 8.6 ± 5.5 days 2
- Outpatient intravenous therapy with daily reassessment by a physician may be a safe alternative to admission in select cases of periorbital cellulitis without systemic signs of illness 4
- The total duration of therapy for periorbital cellulitis has been decreasing in recent years, with durations of approximately 2 weeks becoming more common 5
Use of Corticosteroids in Periorbital Cellulitis
- There is insufficient evidence to draw conclusions about the use of corticosteroids in the treatment of periorbital and orbital cellulitis 6
- One study compared the use of corticosteroids in addition to antibiotics to the use of antibiotics alone for the treatment of orbital cellulitis, but the certainty of evidence was very low 6
- Additional high-quality evidence from randomized controlled trials is needed to inform decision making about the use of corticosteroids in periorbital and orbital cellulitis 6