Preseptal or Orbital Cellulitis Clinical Pathway, All Settings – Clinical Features of Preseptal vs. Orbital Cellulitis

Preseptal or Orbital Cellulitis Clinical Pathway — All Settings

Clinical Features of Preseptal vs. Orbital Cellulitis

Preseptal cellulitis is a cellulitis around the eye but anterior to the septum. The septum is a structure of the eyelid that marks the anterior boundary of the orbit. On exam, the key distinguishing features between these two entities are known as orbital signs.

Orbital cellulitis is an infection behind the septum, often caused by sinusitis. Orbital cellulitis requires IV antibiotic therapy and may also require surgical management. This infection is potentially vision or life-threatening, as the infection can damage the optic nerve or spread to the brain or bloodstream. Careful and frequent ophthalmological examinations are important to monitor the course of the infection and response to treatment. Eye Exam

Orbital Signs

Orbital cellulitis may present with a variable number of these features, which distinguish it from preseptal cellulitis. Each sign is not uniformly present, and the presence of one or more signs should raise concern for an orbital process.

Clinical Finding Orbital Cellulitis Preseptal Cellulitis
Eyelid swelling Yes Yes
Proptosis
Eye bulging outward, this is not the same as eyelid swelling		 Yes No
Ocular surface (conjunctival) redness (injection) or swelling (chemosis):
Whites of eyes look red and/or swollen		 Yes No
Motility limitation
Limitation of movement of eye in any direction (up, down, left, or right)		 Yes No
Strabismus (eye misalignment) and/or diplopia (double vision) Yes No
Pain with eye movements Yes No
Decrease in visual acuity Yes No
Relative afferent pupillary defect (rAPD) Yes No
Optic disc changes (swelling, paleness) Yes No