Orbital Cellulitis

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Definitions of cellulitis involving the eyes

Diagnosis, management and treatment of orbital and periorbital cellulitis in children

Pre-septal, peri-orbital cellulitis

  • Infection confined to the eyelid and superficial tissues anterior to the orbital septum
  • Proptosis and impaired ocular mobility should be absent. 
  • Manage as per Cellulitis.

Post-septal, orbital cellulitis

  • Deeper infection within the tissues of the orbit. 
  • Proptosis may be present.
  • Impairment or painful eye movements.
  • Vision including colour vision may also be affected.
  • This is an emergency. Seek immediate specialist advice from ENT, Ophthalmology and Microbiology. 
  • Consider CT imaging, and drainage.
  • Follow antimicrobial recommendations below.

Antibiotic recommendation

Total recommended duration: 7 days (Total duration = IV + oral)

Recommended Antibiotic

Ceftriaxone 2g every 12 hours IV

AND

Metronidazole 400mg every 8 hours orally (or 500mg every 8 hours IV if oral route unavailable)
Penicillin allergy

Vancomycin IV (use NHS Lothian Calculator located AMT intranet page)

AND

Gentamicin IV (use NHS Lothian Calculator located AMT intranet page)

AND

Metronidazole 400mg every 8 hours orally (or 500mg every 8 hours IV if oral route unavailable)

 

IV to oral switch

Review sensitivities

Recommended Antibiotic Co-amoxiclav 625 mg every 8 hours
Penicillin allergy  

Doxycycline 100mg every 12 hours orally 

AND

Metronidazole 400mg every 8 hours orally

OR

Co-trimoxazole 960mg every 12 hours orally

AND 

Metronidazole 400mg every 8 hours orally

 

Notes

Likely organisms: S. aureus, Group A Streptococci, respiratory bacterial pathogens - Haemophilus, Pneumococcus etc.