Risk Stratification
Preseptal cellulitis is a superficial soft tissue infection that should be considered with respect, but is usually amenable to treatment. Orbital cellulitis is a serious, sight-threatening and occasionally life-threatening disease. The two can look similar, especially in the early stages, but there are clues that point to one or the other.
The following table shows a summary of the key findings for preseptal and orbital cellulitis
| Preseptal cellulitis | Orbital cellulitis | |
|---|---|---|
| Local erythema | Common | Common |
| Chemosis | Rare | Common |
| Proptosis | Not a feature | Common |
| Painful eye movements | Rare | Common |
| Restricted eye movements | Not a feature | Later sign |
| Reduced visual acuity | Not a feature | Late sign |
| Systemic condition | Well | Unwell |
| Preceding eyelid trauma/infection | Common | Rare |
|
Preceding remote infection (commonly sinusitis or
other upper respiratory tract infection) |
Rare | Common |
If there is a doubt as to the diagnosis, an urgent opinion should be requested from a senior doctor in the emergency department or an ophthalmologist.