What is Preseptal Cellulitis?

D. Jeffress

Preseptal cellulitis is a bacterial infection that appears along the eyelid and the corners of the eye. Most cases of preseptal cellulitis develop secondary to sinusitis, but trauma to the eye or eyelid can lead to a primary infection. The most common symptoms are redness and swelling around the eye, and vision may be blurry. Preseptal cellulitis is usually a temporary, minor problem that can be relieved with a short course of antibiotics. If an abscess develops or infection spreads to deeper tissue, surgery and more aggressive medications may be needed to avoid complications.

Amoxicillin is an antibiotic used to treat preseptal cellulitis.
Amoxicillin is an antibiotic used to treat preseptal cellulitis.

Streptococcus and staphylococcus are the leading causes of preseptal cellulitis. Bacteria are most likely to be introduced into the eyelid membrane during an acute sinus or respiratory tract infection. An eye or eyelid injury may also precede cellulitis. Less commonly, patients develop symptoms following surgical procedures near the eyes. Very young children and the elderly are at the highest risk of preseptal cellulitis because their immune systems are generally weaker than people of other age groups.

A person who develops a preseptal cellulitis infection is likely to experience swelling in the upper or lower eyelid and around the perimeter of the eye. If swelling is severe, an individual may have blurred or obstructed vision. Inflammation often causes redness, itchiness, tearing, pus buildup, and mild pain. Other symptoms such as fever, mental confusion, and severe headaches are possible signs that the infection has spread beyond the orbital cavity.

A primary care doctor or an ophthalmologist can diagnose preseptal cellulitis through a simple physical exam. The doctor carefully checks for signs of scratches, punctures, animal bites, and other injuries near the site of infection. He or she may also decide to collect a blood sample or fluid from the eyelid for laboratory analysis. Additional tests, such as computerized tomography scans, are only necessary if the doctor suspects a more serious infection.

Amoxicillin and other common antibiotics are usually successful at clearing up an infection in about two weeks. Patients are encouraged to avoid rubbing their eyes and sharing towels with others to avoid spreading the infection. A doctor can drain a large pus-filled abscess with a needle if vision is obstructed. If an obvious injury exists, a patient may need to use a topical ointment or receive stitches to prevent a recurring eye problem. A follow-up visit with an ophthalmologist after symptoms resolve can confirm that bacteria have been completely eradicated.

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