Alamo Optometry Blog

April 27, 2014


Filed under: Uncategorized — gkblog @ 1:48 pm

(As appeared in Alamo Today, January 2014)

                Recently a patient came into the office with a red and inflamed eyelid.  These are relatively common; the most likely culprits are styes, trauma, allergies, or blepharitis (bacterial infection of the eye lashes).  However, this condition was different in that it was an infection of the eyelid and soft tissue around the eyelids, or preseptal cellulitis.  A cellulitis can be potentially dangerous and the correct diagnosis needs to be made between preseptal and orbital cellulitis. 

                Preseptal cellulitis is a bacterial infection of the eyelid and surrounding soft tissue.   The eyelid area becomes red, swollen, warm to the touch, and potentially painful.  In contrast to a stye, a cellulitis covers a larger area of the eyelid whereas a stye is more localized.  In preseptal cellulitis, the infection is contained in the anterior portion of the lid and has not penetrated the septum (a thin membrane within the eyelid to help prevent infections from spreading deeper into the lids) to the posterior portion of the eye.  It is usually caused by an upper respiratory infection (flu) or sinus infection that has spread to the eye.  Direct insect bites or scratches are also potential ways the bacteria can penetrate the eyelid.   It is much more common in children and it responds well to oral antibiotic therapy.    Vision is not affected and the eye is able to move unrestricted in all directions.  The patient is usually getting over an illness or has been around sick people, but does not actively have a fever.            

Differentiating between a preseptal and orbital cellulitis is very tricky because both clinically present the same.  In orbital cellulitis, the affected eye will appear bulging relative to the healthy eye, the vision will be decreased, and eye movements will be restricted.  The person is concurrently ill and is possibly running a fever.  Functionally, the difference between the two is that in orbital cellulitis, the infection has spread posterior to the back of the eye and to the surrounding structures in the facial area.  This can result in permanent vision loss, neurological problems, and potentially meningitis if it gets into the bloodstream.  Therefore, orbital cellulitis requires hospitalization with continuous IV antibiotics to help control the infection. 

                Granted a cellulitis does not happen very often, but it reiterates the need that sometimes the simple red eye might not be so mundane.  If you notice eyelid redness and swelling that is not localized or is spreading with an associated illness, a cellulitis should be considered.  Preseptal cellulitis is much more common than orbital and is very responsive to oral antibiotics and the symptoms start to resolve in a few days.  The patient should be followed just to ensure the infection is clearing.  However, if an orbital cellulitis is suspected, direct referral to the hospital is required.




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