H05.019/H05.012
DESCRIPTION
Preseptal cellulitis (cellulitis of the tissues anterior to the orbital septum) is generally a mild condition that rarely leads to serious complications, whereas orbital cellulitis (involving the tissues posterior to the orbital septum, including the fat and muscle within the bony orbit) may cause loss of vision and even loss of life.
DIAGNOSTIC CRITERIA
Patients with local tenderness (lid erythema/oedema only) and a normal eye examination can be treated for preseptal cellulitis with oral antibiotics.
However, care should be taken to identify those at risk of orbital cellulitis, who require admission and intravenous antibiotics. CT scan is warranted in patients with central signs (drowsiness, vomiting, headache, seizure or cranial nerve lesion), where vision cannot be accurately assessed, gross proptosis, opthalmoplegia, deteriorating visual acuity or colour vision, bilateral oedema, no improvement or deterioration at 24 hours, or a swinging pyrexia not resolving within 36 hours.
MEDICINE TREATMENT
Initial management:
- Ceftriaxone, IV, 50mg/kg once daily.
OR
If one month old or younger:
- Cefotaxime, IV, 50mg/kg/dose, 6 - 8 hourly
If diagnosis of preseptal cellulitis is confirmed , switch to:
- Amoxicillin/clavulanic acid, oral, 30 mg/kg/dose of the amoxicillin component 8 hourly for 10 days.
If diagnosis of orbital cellulitis is confirmed , continue on intravenous antibiotics.
REFERRAL
- Patients with central signs.
- Patients where vision cannot be accurately assessed.
- Patients with gross proptosis, opthalmoplegia, deteriorating visual acuity or colour vision.
- Patients with bilateral oedema.
- No improvement of deterioration after 24 hours of therapy.
- Swinging pyrexia not resolving within 36 hours.
- Orbital cellulitis secondary to chronic sinusitis (may be risk of multiple abscesses).