Preseptal cellulitis or periorbital cellulitis in children is more common than in adults, and it involves inflammation and infection of the soft tissues around the eyes. It can be due to bacteria and may occur in one or both eyes. The risk for severe complications is rare if it is treated appropriately. Otherwise, it may complicate and cause intracranial infections, such as meningitis, or cause infection posterior to the orbital septum called orbital cellulitis (1).
Redness and swelling in the eye should be evaluated and treated by a pediatrician to avoid these complications. You may also ensure that the recommended medications and home care measures are followed to avoid recurrence.
Read on to learn more about the causes, symptoms, diagnosis, complications, treatment, and prevention of periorbital cellulitis in children.
Causes Of Periorbital Cellulitis In Children
The most common bacteria that cause periorbital cellulitis are:
- Staphylococcus aureus
- Streptococcus pneumoniae
- Streptococcus pyogenes
In rare cases, fungi such as aspergillus or mucorales can cause periorbital cellulitis. The chances of infection due to Haemophilus influenzae has reduced in recent years due to flu vaccinations. However, there have been increased instances of periorbital cellulitis infection caused by the antibiotic-resistant MRSA (methicillin-resistant staphylococcus aureus) (1).
Risk Factors For Periorbital Cellulitis
The following infections or trauma could trigger periorbital cellulitis around the eyes (2):
- Upper respiratory infection
- Impetigo (skin infection)
- A stye (lump on the eyelid)
- Swelling of the lacrimal (tear) gland
- Insect bite
- Animal bite
- Blood infection
You may reduce the risk of periorbital cellulitis by following proper wound care and treating the skin or respiratory tract infections on time.
Signs And Symptoms Of Periorbital Cellulitis In Children
The common signs and symptoms of periorbital cellulitis include (3):
- Erythema (redness of the skin). Skin is red and shiny.
- Swollen eye and eyelids
- Warmness over the eyes. Hot on touching
- Tender on touching
- Eye pain
Seek medical attention if you notice these changes in the eyes of your child. Early diagnosis and treatment could increase the chances of cure and reduce the risk for complications.
Diagnosis Of Periorbital Cellulitis In Children
After the physical examination of your child’s eye, the pediatrician may suggest any of the following tests (4):
- Visual examination: Your doctor may check your child’s visual acuity, eye muscle movements, and the intraocular pressure (pressure of the eye).
- Neurological examination: The pupil’s reaction to light and its accommodation is analyzed. Your doctor may also look for brain functions such as balance, coordination, etc., to ensure there are no intracranial complications.
- Blood tests: This may help to identify the bacteria and other inflammation and infection-related changes in the blood.
- Analysis of eye secretions: Secretion samples from the eye may help to identify the bacteria.
- Imaging: Magnetic resonance imaging (MRI) and computed tomography (CT) may be used to find a foreign object, abscess, or rupture of the eye.
In most cases, your doctor may recommend treatments after the clinical diagnosis. CT scans are usually ordered to rule out orbital cellulitis and identify intracranial complications. Blood tests are not always suggested since they can be negative in several cases.
Treatment For Periorbital Cellulitis In Children
The treatment varies depending on the age of the child and the severity of the disease. However, two weeks of appropriate treatment can cure periorbital cellulitis.
In severe cases, children, especially those below one year of age, may require hospitalization. Hospitalization occurs to provide intravenous antibiotics and treat associated complications. Older children with mild infection can be treated with oral antibiotics in outpatient settings.
Your child’s pediatrician may recommend any of the medications listed below (1):
- Antibiotics: Antibiotics are given to inhibit the growth of bacteria. Usually, five to seven days of treatment with antibiotics such as clindamycin, TMP-SMX plus amoxicillin-clavulanic acid, or cefdinir is recommended. If cellulitis persists, an extended treatment is needed. Broad-spectrum antibiotics are given if your child is not vaccinated for influenza virus.
- Acetaminophen: This is used to treat fever and pain. Although it is available over the counter, you may get a doctor’s prescription for exact dosing. An overdose of this drug could result in liver damage.
- NSAIDs (ibuprofen): This drug helps to reduce pain, swelling, and fever.
- Surgical drainage: If the cellulitis complicates into an abscess, your doctor may recommend surgery to drain the pus.
Most children show immediate responses to antibiotics treatment in outpatient settings. The condition is quite painful and the child needs pain relievers and antibiotics to treat the infection and prevent complications. However, if there are no signs of improvement within one or two days, your child may need hospitalization and further treatments.
Tips To Prevent Periorbital Cellulitis In Children
The following tips may help to prevent periorbital or preseptal cellulitis in children (5):
- Follow good hygiene practices.
- Protect your child with safety equipment while playing sports.
- If they have any wounds, keep them clean.
- You may use antibiotic ointments on injuries to prevent contamination.
- Do not let them swim if they have a wound.
- Give the recommended vaccinations on time.
- Get the early eye infections treated.
- Child should not rub infected eyes.
- Cut the nails of the child regularly, so that they do not scratch infected boils on skin and then rub the eye.
- Treat insect bites urgently.
The Hib and pneumococcal vaccines may help to prevent periorbital cellulitis in children. You may also take care of any injuries on your child’s skin. Recurrence and complications of periorbital cellulitis can be restricted by following the prescribed course of medications.
When To See A Doctor
You should contact your child’s healthcare provider if you have any concerns about the condition or if you notice the following (6):
- Red and swollen eyes
- Pus draining from the eyes
- Red streaks on the infected area of the skin
Sometimes, periorbital cellulitis may lead to emergencies. You may call emergency if you notice any of the following in your child:
- Difficulty in breathing
- Trouble waking up from sleep
You may seek an immediate medical consultation if your child has:
- Stiff neck
- Blurred vision
- Diplopia (double vision)
- Sensitivity to bright light
- Bulging of the eye
The above indicate intracranial complications. Although it is not a severe condition, following a proper treatment plan could prevent intracranial complications, which may be fatal. Untreated periorbital cellulitis can also lead to vision loss. Give the full course of antibiotics.
Frequently Asked Questions
1. How serious is periorbital cellulitis?
Periorbital cellulitis usually improves with treatment. Rarely, especially if left untreated, the infection around the eye can spread to the eye, resulting in orbital cellulitis and potentially causing vision problems (7).
2. Can periorbital cellulitis spread to the brain?
If periorbital cellulitis develops into orbital cellulitis, there is an increased risk of spread to the brain. Since the eyes are connected to the brain through optic nerves, orbital cellulitis can cause brain abscess and vision loss and be severe in some cases (8).
3. Does poor hygiene cause periorbital cellulitis?
Periorbital cellulitis is not caused by poor hygiene in children. It may spread through the venous system of the eye during sinusitis or other upper airway infections (9).
4. How long does periorbital cellulitis take to heal?
The exact healing time for periorbital cellulitis may vary in children. Usually, most children feel better within 24 to 48 hours after taking antibiotics, and it usually resolves within five to seven days of antibiotic therapy (9).
5. Will periorbital cellulitis go away without antibiotics?
Antibiotics are the principal treatment for periorbital cellulitis and are recommended to prevent complications. Early diagnosis and treatments can improve outcomes in most cases (9). Mild cases can be treated at home with oral antibiotics, and severe cases may require hospitalization and intravenous (IV) antibiotic therapies.
Periorbital cellulitis in children can be managed with proper care, timely diagnosis, and treatment. All the aforementioned require you to be aware of the common symptoms such as swollen and warm eyes, skin redness, and fever. Although most of the time, a course of antibiotics is suggested as the first form of treatment depending upon the severity and age of the child, surgical intervention or other treatments may be adopted in case of complications. So, it is recommended to stay alert and follow preventive measures to minimize the risks of periorbital cellulitis in children.
2. Seongmu Lee and Michael T. Yen; Management of preseptal and orbital cellulitis; Saudi Journal of Ophthalmology (2011).
3. Periorbital cellulitis; The United States National Library of Medicine
4. Robert Thomas Carlisle and John Digovanni; Differential Diagnosis Of The Swollen Red Eyelid; American Family Physician (2015).
5. Cellulitis; Harvard Health Publishing; Harvard School of Medicine
6. Cellulitis of the eye in children; University of Rochester Medical Center (URMC)
7. Periorbital Cellulitis; Mount Sinai
8. Periorbital And Orbital Cellulitis; JAMA Network
9. Crystal Ba And Daniele Bourget; Periorbital Cellulitis; National Library of Medicine (2021)