How do you tell the difference between orbital/preseptal cellulitis?
Orbital cellulitis is uncommon. Signs suggesting orbital cellulitis i.e. infection behind the eye, within the orbit, include: proptosis, decreased visual acuity, loss of colour vision/colour desaturation, abnormal pupil reactions, restriction of eye movements (ophthalmoplegia), red eye, significant pain and pyrexia. This is usually as a result of spread from sinusitis.
Orbital cellulitis is treated with IV antibiotics. Patients may require a CT scan to assess for orbital collection/abscess and if present this may need drained.
Preseptal cellulitis is much more common and it usually has a localised precipitating infection e.g. infected acne, cyst, chalazion, dacrocystitis or laceration. The lids alone are affected with no change in vision and the eye examination is otherwise normal.
Treatment of preseptal cellulitis is with oral antibiotics, if systemically well, as per Lothian antimicrobial guidelines for cellulitis- flucloxacillin 500mg QDS. It can take 48 hours for improvement in symptoms to occur.
Swollen lids can also be caused by allergy and conjunctivitis. They do not require oral antibiotics.
Who to refer:
Please see Lothian GP and optometry ophthalmology referral pathway.
Urgency of the condition for details on how soon patients should receive an appointment.
Patients who present with a problem with their only seeing eye should be advised to see an optician/ophthalmologist for review.
How to refer:
We require a referral letter for EVERY patient.
The preferred referral process is via SCI Gateway. If sending/forwarding a referral via SCI gateway please include past medical history, allergies and medications
If you do not have access to fax or SCI Gateway e.g. if you have arranged an appointment out of hours please send a written referral letter with the patient to bring to their appointment.
Only if SCI Gateway is unavailable should a letter be typed or handwritten. Please write legibly and include your examination findings.
If you have arranged an appointment in the acute referral clinic and you are referring from within another hospital in Lothian please use TRAK to type the referral letter.
