Periorbital cellulitis


  • Also known as "preseptal cellulitis"
  • Most often due to contiguous infection of soft tissues of face and eyelids
  • Most patients are <10yr
  • Rarely leads to orbital cellulitis

Periorbital vs Orbital Cellulitis

Clinical Features

Periorbital cellulitis


  • Swelling, tenderness, and erythema of eyelids and superficial tissues surrounding the orbit
  • +/- fever
  • Lack of:

Differential Diagnosis

Periorbital swelling


No proptosis

Lid Complications



Periorbital cellulitis caused by a dental infection (also causing maxillary sinusitis).
  • CT Orbit with IV contrast if:
    • Concern for orbital cellulitis-i.e. equivocal assessment of proptosis, red eye, EOM function or pain w/ eye movement
    • Unable to accurately assess vision (e.g. age <1yr)




Treatment recommended for 5-7 days. If signs of cellulitis persist at the end of this period, treatment should be continued until the eyelid erythema and swelling have resolved or nearly resolved.

- In children: 8 to 12 mg/kg QD of the TMP component divided every 12 hours

- In children: 30 to 40 mg/kg per day in three to four equally divided doses, maximum 1.8 grams per day

PLUS one of the following agents:

- In children: usual dosing is 45 mg/kg per day divided every 12 hours; dosing for severe infections or when penicillin-resistant S. pneumoniae is a concern (using the 600 mg/5 mL suspension) is 90 mg/kg per day divided every 12 hours

- In children <12 years of age: 10 mg/kg per day divided every 12 hours, usual maximum dose 200 mg; in children ≥12 years and adolescents: 400 mg every 12 hours

- In children: 14 mg/kg per day, divided every 12 hours, maximum daily dose 600 mg


Vancomycin 15-20mg/kg IV BID + (one of the following)


  • If well-appearing and afebrile consider discharge

See Also