Guidelines
Preseptal & Orbital Cellulitis

Preseptal & Orbital Cellulitis

Microbiology

Initial Management

Inclusion Criteria:

  • Eye swelling concerning for preseptal or orbital cellulitis

Exclusion Criteria:

  • Evidence of non‐cellulitic cause of eye swelling (e.g., allergy, chalazion, blunt trauma, conjunctivitis, dacryocele)
  • Supero‐lateral abscess on CT (will need orbital surgeon)
  • Posterior table erosion of the frontal sinus bone with brain abscess
  • Any patient requiring neurosurgical involvement

Ophthalmology Consult

Place for:

  • Urgent calls for any orbital involvement (clinically or on CT) OR
  • If ENT taking to operating room

Initial Evaluation:

  • History including diplopia, systemic symptoms
  • Physical exam findings, including:
    • Extent of eyelid edema/erythema
    • Presence of proptosis
    • Ocular motility/pain with eye movement
    • Pupillary reaction/afferent pupillary defect
    • Vision with Snellen chart, if possible
  • Labs: CBC w/differential, CRP (unless mild preseptal cellulitis signs and/or attending discretion); If ocular discharge, obtain bacterial culture

Algorithm

  • Pain w/eye movement
  • EOM’s restricted/diplopia
  • Proptosis
  • ANC >10,000 cells/µL
  • Cannot assess d/t extensive eyelid edema

Additional Resources

Contacts:

  • Majida Gaffar, MD
  • Eric Hoppa, MD
  • Hareem Park, MD
  • Scott Schoem, MD

Last Updated: 7.28.21