Preseptal or Orbital Cellulitis Clinical Pathway — All Settings

IV access, Laboratory Studies
Assure NPO
Antibiotic Recommendations
Imaging
- CT Orbit, Sinuses with IV Contrast
- Sedation Considerations
Consults
- Ophthalmology: All patients
- ENT: Significant sinus disease
- Neurosurgery: Intracranial extension
- Infectious Disease: As clinically indicated

Considerations for Surgical Management
For possible surgical cases
- Ophthalmology/ENT attending discussion

Admit Inpatient

Admit OR Surgical Drainage

Admit PICU
Altered mental status
Sepsis
Intracranial extension
Consult as indicated
- ID, Neurosurgery

Inpatient Care

Antibiotic Recommendations
Ophthalmology consult as clinically indicated
ID Consult as clinically indicated

Antibiotic Recommendations
Nasal Therapies Not Routinely Recommended
Steroids per ophthalmology and ENT
Ophthalmology Consult
Other Consults as indicated

Monitor Response to Therapy

More frequent exams as clinically indicated, EPIC Images

Daily Ophthalmology Service Exam, EPIC Images
More frequent exams as clinically indicated

Good Treatment Response

Inadequate Treatment Response

Good Treatment Response

Inadequate Treatment Response

Improved
- Clinical findings
- Fever curve
Tolerating PO intake

After 36 hours of treatment
- No improvement
  - Clinical findings
  - Fever curve

Review Antibiotic Escalation
Consider imaging
Consider Ophthalmology Consult

Improved clinical findings
Afebrile for 24 hours
Tolerating PO Intake

After 36 hours of treatment
- Worsening orbital signs by ophtho exam

Consult ID for Antibiotic Escalation
Consider repeat imaging
Reconsider Surgical Management
- Ophthalmology/ENT Attending Discussion

Transition to Oral Therapy

Discharge

Follow-Up Recommendations

Posted: April 2019
Revised: June 2022
Authors: G. Binenbaum, MD; L. Lin, MD; I. Kuhn, CRNP; M.Russo, MD; T. Kaur, MD; J. Lavelle, MD; M. Hayes, PharmD; W. Katowitz, MD;
K. Reddy, MD; M. Rizzi, MD; K. Revere, MD; A. Buzi, MD; M. Blackstone, MD; C. Wilbur, MD; V. Scheid, MD

Evidence

CHOP Programs

Division of Ophthalmology

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us.

©2024 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.