How is periorbital cellulitis treated?

Updated: Jul 31, 2018
  • Author: Bobak Zonnoor , MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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In adult patients who are nontoxic and can be assured of appropriate follow-up, treatment can be administered with oral antibiotics on an outpatient basis. No evidence suggests that intravenous antibiotics are superior to oral antibiotics in the management of simple periorbital cellulitis in terms of faster recovery or prevention of complications. [66] The antibiotic should offer coverage of Staphylococcus and Streptococcus. [43]

Patients who undergo outpatient treatment should be seen daily to ensure clinical improvement. The length of antibiotic treatment is 7-10 days; however, it should be guided by symptom resolution. Clinical improvement should be evident within 1-2 days after initiation of antibiotics. [67] Nasal decongestants may be used for the short term to reduce mucosal edema. [61]

Inpatient care, with administration of intravenous antibiotics, is indicated for the treatment of periorbital cellulitis in most pediatric patients. Full septic evaluation must be considered if the patient is toxic-appearing or has any signs of nervous system involvement (eg, headache, vomiting, seizure, cranial nerve deficits). [43] Once clinical improvement is noted, the patient should be switched to oral antibiotics. 

A Clinical Severity Index has been established for periorbital cellulitis in children. It uses systemic features of patient interaction and fever, as well as local features of location, erythema, extent of eye opening, and pain and tenderness. [68]

Patients with an infection of odontogenic origin may have improved outcomes with early definitive treatment of dentition. [69]

Assessment considerations

A study by Upile and colleagues indicated that in most cases, daily assessment of hospital patients with periorbital cellulitis only infrequently requires an otorhinolaryngologist, despite concerns regarding possible intracranial and orbital complications in these patients. Using a retrospective analysis of 213 case notes from a tertiary children’s hospital, the investigators found that most patients were successfully managed by pediatricians and ophthalmologists.

Upile et al concluded that in patients with periorbital cellulitis, otorhinolaryngologic assessment is required only after first-line treatment of the disease has failed. [70]

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