Pre-septal cellulitis

8 Jan

Pre septal cellulitis includes the anterior eyelid w/o affecting the structures around the eye including muscle and fat.

When it affects orbital structures – may cause:

  • ophthalmoplegia,
  • pain with eye movements,
  • proptosis.

Orbital cellulitis is more emergent condition that can cause loss of vision or death.

Pre septal usually from trauma, sinusitis, contiguous infection, animal or insect bites, or foreign body. Usually caused by strep.

CT to r/o orbital cellulitis.

Antibiotics should target strep but also cover for MRSA as well. Clindamycin or Bactrim plus amoxicillin or amox/clav.

Ensure h. flu vaccinated, if not then use the combo regimen.

Treat for 7-10 days.

EMRA Antibiotic Guide suggestions for periorbital cellulitis (outpatient tx):

  • amoxicillin/clavulanate 875mg BID x 7-10 days
  • cefpodoxime 200mg BID x 7-10 days
  • Cefdinir 600mg daily x 7-10 days
  • cephalexin 500mg four times a day x 5 days
  • clindamycin 450mg TID x 5 days

Inpatient treatment:

  • treat like orbital cellulitis
  • big guns (e.g. vancomycin PLUS [amp/sulbactam, ceftriaxone, levofloxacin+metronidazole, or clinda])

If failed outpatient tx, should be admitted for IV Abx.

 

Submitted by J. Rothstein.

References: emedicine article; 2013 EMRA Antibiotic guide; picture

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