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.