Wednesday, Jun 1, 2022 by Nisha Gupta, MD

Our last installment on red eye will be preseptal and orbital cellulitis.

What are preseptal and orbital cellulitis?

Preseptal cellulitis is an infection of the front part of the eye. Usually, it is caused by a bacterial infection, but certain viruses and fungi can cause it as well. The infection may occur from eyelid trauma or insect bite, spread from another infection in the sinuses or skin, or travel through the bloodstream. Orbital cellulitis is a more severe infection that spreads to the back parts of the eye.

What are the symptoms?

Most patients will have eyelid swelling and redness. The skin may feel warm to the touch and patients occasionally have a fever and fatigue. Preseptal cellulitis does not affect the vision or eye movements. If the infection spreads into an orbital cellulitis, the vision is usually decreased, eye movements are painful, the eye can be red, and the eye bulges.

How is this diagnosed?

A comprehensive eye exam is needed to diagnose preseptal cellulitis and distinguish it from orbital cellulitis. The eye exam includes checking visual acuity and eye pressure, slit lamp exam, and dilated eye exam. Occasionally cultures of the blood or wound are necessary to determine what organism is causing the infection. If the eyelid swelling is severe, a CT scan or MRI may be necessary.

What are the treatments?

Most cases of preseptal cellulitis can be treated with oral antibiotics and follow up with an ophthalmologist in the clinic to ensure full recovery. Severe cases or cases of orbital cellulitis are treated in the hospital with intravenous (IV) antibiotics. Rare complications can occur which may require additional treatments such as surgery to drain an abscess.

Remember, there are many causes for red eyes. Make sure to see an ophthalmologist for any new symptoms and get treatment if necessary.

Return next month for a discussion on a new topic!

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