Peri-Orbital and Orbital Cellulitis

Reference: 1694 Written by: Judith Gilchrist Peer reviewer: Lucy Hinds Approved: November 2017 Review Due: September 2021

Purpose To guide the management of periorbital and orbital cellulitis

Intended Audience Clinical staff managing the patient

Author: Judith Gilchrist Review date: September 2021 © SC(NHS)FT 2017. Not for use outside the Trust. Page 1 of 3 CAEC Registration Identifier: 1694 Sheffield Children’s (NHS) Foundation Trust Peri-Orbital and Orbital Cellulitis

Table of Contents 1. Introduction 2. Guideline Content A. Pre-septal Cellulitis B. Orbital Cellulitis 3. References

1. Introduction

Pre–septal (periorbital) cellulitis is a common condition and the majority of cases can be managed on oral antibiotics and discharged home. Orbital cellulitis is however a serious condition with significant long term morbidity and requires aggressive management. Differentiating between the two conditions is important but fortunately relatively simple.

2. Intended Audience

Clinical staff managing the patient

3. Guideline Content

A. PRE-SEPTAL CELLULITIS

Symptoms include lid swelling and redness.

Signs include lid swelling and erythema but otherwise normal eye examination.

Take history and perform basic eye examination – remember to check visual acuity, pupils and eye movements.

Management

If under 3 months old - admit under medics and refer to ophthalmology and ENT.

If over 3 months old – If systemically well, sensible parents and mild features may be discharged on PO antibiotics (co-amoxiclav).

Author: Judith Gilchrist Review date: September 2021 © SC(NHS)FT 2017. Not for use outside the Trust. Page 2 of 3 CAEC Registration Identifier: 1694 Sheffield Children’s (NHS) Foundation Trust Peri-Orbital and Orbital Cellulitis

Mild features include - Lids can be opened, the eye itself is not red, eye movements and visual acuity are normal and none of the symptoms or signs of orbital cellulitis below are present. Give clear instructions to return immediately if condition worsens (increased swelling or child becomes lethargic, develops fever, vomiting or blurred vision).

B. ORBITAL CELLULITIS

Symptoms include: General malaise, pain, blurred vision, double vision, loss of colour vision, sinus headache.

Signs include: Significant eyelid swelling, erythema, warmth, tenderness, conjunctival chemosis and injection, proptosis and/or restricted eye movements often with pain on attempted eye movements. Signs of optic neuropathy (reduced vision, Relative Afferent Pupillary Defect, abnormal colour vision) may be present in severe cases. Child is usually systemically unwell.

Management Take history and perform basic eye examination – remember to check visual acuity, pupil responses and eye movements. Admit for IV antibiotics and refer to ophthalmology and ENT urgently.

Recommend I.V antibiotics as per 17.1 (D) section:1ST line Flucloxacillin + Cefotaxime + Metronidazole. 2nd line Clarithromycin and Metronidazole.