Periorbital Cellulitis In Children

  • Nurah Ekhlaque Masters in Biotechnology, Guru Ghasidas University, India
  • Aleena Asif Bachelor of Engineering in Biomedical Engineering, Queen Mary University of London
  • Arghavan Kassraie Bachelor of Engineering - BEng, Biomedical Engineering, University of Strathclyde

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It is an infection involving the eyelid and the surrounding areas of the face but not extending beyond the orbital septum. This usually takes the form of the lids: swelling, redness, and sometimes fever or eye pain. Early recognition and intervention are therefore very key in averting possible complications, such as the extension of infection into more vital areas like the orbit, hence causing orbital cellulitis, which is of higher severity and can compromise vision. 

Read on

For those eager to learn more, this article delves deeper into causes, symptoms, diagnosis, treatment, and preventive measures for periorbital cellulitis in children. We’ve gathered comprehensive information to help you understand this condition better and take the necessary steps to protect your child's health. Keep reading to equip yourself with the knowledge needed to tackle periorbital cellulitis confidently.

Introduction

Periorbital cellulitis is a type of bacterial infection of the skin and other structures around the eye that sometimes causes death in children. This thus remains a condition of concern, though it is mostly manageable with early medical intervention. Having such knowledge would definitely give the caregivers an upper hand to be proactive in a bid to ensure the safety of the affected children by understanding the subtleties like causes and prevention.¹

Causes

  • Staphylococcus aureus: Among the bacteria in the environment, Staphylococcus aureus is one of the most notorious etiological agents for periorbital cellulitis.
    • This bacterium is known to cause various skin infections, of which it may become very aggressive when the soft areas near the eyes are infected.
  • Streptococcus species: Members of a variety of Streptococcus bacteria, which form part of the normal flora of the human body, like Streptococcus pyogenes and Streptococcus agalactiae; however, they have been known to cause disease when they reach infective sites through a breach in protective coverings of the skin.
  • Entry of the body is through any break in the skin. This includes cuts, abrasions, or any open wound.
    • Need to be kept clean and provide proper care, more so for the facial open wound.
  • Spread from Neighboring Infections: Sinuses, in the course of their diseases, could be to blame for an infection that spreads to the eye. This points out that infections all around the eyes should be handled promptly to avoid a spread effect.
  • Sinus Infections as a Pathway: Sinus infections may make an easy pathway for periorbital cellulitis to reach the eyes because the sinuses are very close to the eyes.
    • Further development of the sinus infection must be stopped to manage the problem.
  • Direct Trauma from Scratches or Insect Bites: Scratches, insect bites, or any direct injury on the skin around the eyes provide easy access portals for the bacteria to develop and be able to cause infection.
    • Such incidents point toward the requirement of urgent healthcare and the disinfection of such wounds.
  • Surgery as a Cause: All surgical procedures around the eye are a potential source because of their opportunity to unintentionally introduce bacteria to such vulnerable tissues surrounding the orbit. The sterile technique and postoperative care have much stress in preventing their infection.

Symptoms

  • Swelling of the Eyelids: This normally is the first and fairly acute visible sign. The eyelids will be significantly puffed up or swollen, at times to the extent that opening the eye becomes difficult.
  • Redness: The skin around the eyes, including that on the eyelids, may become visible with redness, which is a sign of inflammation or infection.
  • Warmth: The area of contact around the infected eye was warmer than the ambient skin; this is classic for inflammation.
  • Fever: May have fever due to the body's response to the infection.
    • It may come in isolation or even be associated with other constitutional symptoms of feeling unwell—e.g., drowsiness, and irritability.
  • Pain: The child might experience discomfort or pain around or inside the eye, which can vary from mild to very strong. Pain gets worse with eye movement or light.
  • Sudden Severity: Symptoms, which may start mild and moderate up to a given time, will suddenly worsen, and sometimes they appear with great intensity within a very short time.
    • This should be a signal to look for prompt medical attention. They should be watched with great closeness, for many cases change for the worse very rapidly. For any marked change in the symptoms, that should be a signal for immediate consultation.¹

Guidelines on when to seek medical attention

Immediate medical consultation is recommended when these symptoms are observed, especially if there is no improvement with initial home care or if they rapidly worsen. Early medical intervention will prevent it from proceeding to more severe conditions.

Diagnosis

Importance of Medical History and Physical Examination: The first step for the diagnosis of periorbital cellulitis is the physical examination of complete and focused eyes, which includes reviewing the medical history of the child. It further helps in differentiating periorbital cellulitis from its more sinister counterpart, orbital cellulitis, and so becomes important in the way forward of management.

Differential from other conditions: An initial evaluation is most helpful for the health care provider to come up with a differential diagnosis between periorbital cellulitis from other conditions, which guides the plan of treatment in the right direction.

Additional diagnostic tests

  • Blood Cultures: In some instances, the health professional may want to draw blood cultures to view the actual bacteria causing the infection. This test is particularly useful when a child looks very sick or when there is no response to the initial antibiotic therapy.
  • A swab from the infectious site: Swab from an open wound or discharge can be used to identify the bacteria coming directly from the source of infection.

CT and MRI Scans: Other imaging studies may also be necessary for the exclusion of orbital cellulitis or to assess the extent of its infection. The tests may simultaneously identify other complications to be treated using other methods of therapy.

Treatment

Overview of antibiotic therapy

Primary Treatment—Antibiotics: The mainstay of therapy includes antibiotics targeting the eradication of the bacterial infection responsible for periorbital cellulitis. The antibiotic used depends on the most likely causative bacteria and the severity of the infection.

Oral vs. Injectable Antibiotics: Oral antibiotics might work okay for mild or moderate cases, but for serious bacterial infections such as in the ears and respiratory tract, one has to go for intravenous (IV) antibiotics, and this would mean hospitalization.³

Criteria for hospitalisation

Major cases, especially in young children, or if the first treatment is not effective, require hospitalisation. These will ensure the possibility of monitoring and performing intravenous antibiotic therapy according to what is needed, among other interventions.

Home care and management strategies

The patient needs to complete the full course of the antibiotics taken and observe the progress in every case treated at home. Proper hygiene should be maintained to contain the spread of infection. The caretaker should be prepared to avail of further medical care in case of worsening symptoms.²

Prevention

Preventative measures to reduce risk

Effective preventive measures include good hygiene, early treatment of cuts and other wounds, and early management of sinus infections. However, some vaccinations may be important in preventing some types of bacterial infections that can lead to periorbital cellulitis.

Importance of hygiene and wound care

Thus, usual handwashing, attention to injuries in the face without any delay, and awareness education to children not to touch their eyes with dirty hands will be preventive practices.

When to see a doctor?

Symptoms Necessitating Immediate Medical Consultation They should seek medical care as soon as the sudden appearance of symptoms, severe pain, change in vision, or lack of improvement from the initial treatment being undertaken in the child is noticed. All these signs and symptoms need professional medical evaluation and probably urgent treatment. The Collaborative Role of Pediatricians and Ophthalmologists

Generally, evaluation and management of the child with periorbital cellulitis are done by paediatricians themselves. Consultation with an ophthalmologist needs to be done if serious infectious involvement is suspected or complications are feared that may hamper vision, for comprehensive care of the child.

Summary

Periorbital cellulitis in children is a treatable condition when identified and managed promptly. Key to this management is an understanding of the causes, such as bacterial infection, and the signs that indicate its presence, including eyelid swelling and redness. Effective treatment often involves antibiotics, with the approach tailored to the severity of the condition. Prevention plays a crucial role, with hygiene and proper wound care being paramount. Always consult a healthcare provider if periorbital cellulitis is suspected, as early intervention can prevent complications.

FAQs

What is the difference between periorbital and orbital cellulitis?

Periorbital cellulitis is an infection of the eyelid and surrounding skin that doesn't extend beyond the orbital septum. In contrast, orbital cellulitis is a more severe infection that affects the eye socket (orbit) and can lead to vision problems.

How can periorbital cellulitis be prevented in children?

Prevention focuses on reducing the risk of infection through proper hygiene, timely treatment of nearby infections, and careful attention to wound care.

When should I seek medical attention for my child?

Immediate medical attention should be sought if there is a rapid onset of symptoms such as eyelid swelling, redness, pain, or fever, especially if these symptoms worsen or do not improve with initial care.

References

  1. Bae, Crystal, and Daniele Bourget. ‘Periorbital Cellulitis’. StatPearls, StatPearls Publishing, 2024. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK470408/.
  2. Lahmini, W., et al. ‘Management of Periorbital Cellulitis at the Pediatric Emergency Department: A Ten Years Study’. Journal Francais D’ophtalmologie, vol. 45, no. 2, Feb. 2022, pp. 166–72. PubMed, https://doi.org/10.1016/j.jfo.2021.09.012.
  3. Al‐Nammari, Shafic, and Benjamin Roberton/Craig Ferguson. ‘Should a Child with Preseptal Periorbital Cellulitis Be Treated with Intravenous or Oral Antibiotics?’ Emergency Medicine Journal : EMJ, vol. 24, no. 2, Feb. 2007, pp. 128–29. PubMed Central, https://doi.org/10.1136/emj.2006.045245.
  4. Gonçalves, Rita, et al. ‘Periorbital Cellulitis in Children: Analysis of Outcome of Intravenous Antibiotic Therapy’. Orbit (Amsterdam, Netherlands), vol. 35, no. 4, Aug. 2016, pp. 175–80. PubMed, https://doi.org/10.1080/01676830.2016.1176205.

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Nurah Ekhlaque

Masters in Biotechnology, Guru Ghasidas University

I'm a highly motivated and skilled biotechnology professional, known for my strong background in research and laboratory work. My proficiency extends to cryosectioning, immunohistochemistry, confocal imaging, and various molecular biology techniques. I am detail-oriented and dedicated to consistently producing high-quality results.

My educational journey led me to a Master's degree in Biotechnology from Guru Ghasidas Vishwavidyalaya, India. This academic foundation, combined with my practical experience, fuels my commitment to advancing scientific research and improving human health.

My practical experience includes roles as a Research Assistant at Saarland University in Germany and as an Internship Research Trainee at the All India Institute of Medical Sciences. In these positions, I mastered the use of cryosectioning, immunohistochemistry, and various laboratory techniques, consistently delivering high-quality data for scientific research.

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