Periorbital cellulitis is an infection of the eyelid and the surrounding skin and soft tissue. It can have similar symptoms to a more serious condition called orbital cellulitis. People should see a doctor if they notice any symptoms of periorbital cellulitis.

Unlike orbital cellulitis, periorbital cellulitis does not affect the eyeball. However, without treatment, orbital cellulitis can occur.

In this article, we discuss what periorbital cellulitis is and how it differs from orbital cellulitis. We also look at how it occurs and how to treat it.

Periorbital cellulitis is an infection of the eyelid and the surrounding skin. Doctors may also refer to the condition as preseptal cellulitis. People with periorbital cellulitis experience a swelling of the eyelid in one eye.

A 2020 article notes that it is more common in children than in adults.

In rare cases, the infection can cause complications. However, most cases resolve after 5–7 days of taking antibiotics.

The symptoms of periorbital cellulitis typically affect one side of the face.

The eyelid and surrounding skin will become inflamed and change color. The British Association of Dermatologists notes that while white skin may become red or pink, in people with black or brown skin, the skin may appear purple. In some cases, there may be a subtle darkening of the existing skin color.

Most people with periorbital cellulitis have normal vision, but additional symptoms may include:

  • swelling
  • pain and tenderness
  • difficulty opening the eyelid

Some people may experience less common symptoms, such as:

  • fever
  • teary eyes
  • discharge
  • affected vision

There are several possible causes of periorbital cellulitis, including:

  • sinus infection
  • insect bite
  • facial trauma
  • dental surgery

According to the American Academy of Ophthalmology, cellulitis is more common during the winter because people tend to get sinus infections during that time of the year.

Periorbital cellulitis can occur due to a bacterial infection. Common bacterial causes include:

  • Staphylococcus aureus
  • Haemophilus influenzae
  • Streptococcus

In rare cases, fungi can also cause periorbital cellulitis.

Doctors will take a medical history and perform a physical exam to diagnose periorbital cellulitis. They may ask the individual whether they have a history of bug bites or sinus infections.

A CT scan can help differentiate between periorbital cellulitis and orbital cellulitis.

If a doctor is still unsure, they may take a cautious approach and assume a diagnosis of orbital cellulitis.

A 2020 study suggests that early intervention for periorbital cellulitis can help improve the outlook for people with this condition.

As a result, periorbital cellulitis is not typically a cause for concern. However, without treatment, it can progress and cause serious complications.

The treatment options will depend on the age of the person and the progression of the infection.

In people over the age of 1 year, doctors will prescribe oral antibiotics for the infection.

However, hospital admittance will be necessary for infants under 1 year of age and people with a severe infection. In the hospital, people will receive intravenous antibiotics.

Antibiotics that can treat periorbital cellulitis include:

  • doxycycline
  • amoxicillin
  • cefuroxime
  • ceftriaxone
  • trimethoprim
  • piperacillin

Sometimes, doctors may need to perform surgery to drain any abscesses.

Periorbital cellulitis affects the eyelid and surrounding skin, whereas orbital cellulitis is an infection of the eye tissues. However, the symptoms can appear similar.

Almost all orbital cellulitis cases occur because of an untreated bacterial sinus infection. In some cases, an abscess forms.

The symptoms of orbital cellulitis include:

  • swelling around the eye
  • inflamed skin
  • pain and tenderness to the touch
  • pain while moving the eyeball
  • double vision
  • blurry vision
  • a bulging eyeball

The treatment for orbital cellulitis also involves antibiotics. If antibiotics do not help, a person may require surgery.

Surgery for orbital cellulitis involves drainage of the area or the abscess, if one is present. People may need to take antibiotics after surgery to prevent a recurrence of the infection.

Without treatment, periorbital cellulitis can lead to complications, including orbital cellulitis.

Other possible complications include:

Subperiosteal abscess

This complication occurs when a collection of pus develops between the wall of the orbit and the surrounding areas. The orbit is the space in the skull that contains the eye and surrounding muscles, nerves, and blood vessels.

This type of abscess can lead to:

  • impaired vision
  • ophthalmoplegia, which is weakness or paralysis of the eye muscles
  • pain with eye movement
  • chemosis, which is the swelling of the conjunctiva, the tissue that lines the insides of the eyelids and covers the whites of the eyes
  • injected conjunctiva, which is when the vessels in the conjunctiva become enlarged
  • proptosis, which is the bulging of the eyes
  • fever
  • an increase in white blood cells, or leukocytosis

Orbital abscess

This is the collection of pus that develops within the orbital tissue.

This type of abscess can lead to:

It can also extend and rupture into the eyelids.

Cavernous sinus thrombosis

This is a blood clot that develops in the sinuses, potentially causing symptoms in the opposite eye.

Some conditions that affect the eye area can present in a similar way to periorbital cellulitis.

These include:

  • insect bites
  • allergic reaction
  • stye
  • pinkeye
  • chalazion, which is a small lump or cyst that can develop within the eyelid
  • orbital cellulitis
  • Pott’s puffy tumor, which is a serious complication resulting from infectious sinusitis
  • cavernous sinus thrombosis

Cellulitis infections can spread rapidly. If a person notices any symptoms of periorbital cellulitis, they should contact a doctor.

While some minor eye infections, such as a stye or pinkeye, will go away on their own, periorbital cellulitis requires treatment with antibiotics.

Periorbital cellulitis may spread to other areas of the eye and cause complications. Treatment helps stop the spread of infection. In some cases, untreated periorbital cellulitis can lead to vision problems or blindness.

Periorbital cellulitis is an infection that affects the eyelid and the surrounding area. It can cause marked swelling and skin discoloration in the affected area.

Although it can affect anyone, the condition is most common in children.

Periorbital cellulitis is treatable with antibiotics. However, without treatment, it can progress to orbital cellulitis, which is a potentially life threatening infection that affects the eyeball itself.

As periorbital cellulitis can resemble orbital cellulitis, a doctor may order a CT scan to help determine which type of infection is present.

If a person develops pain or irritation around their eyes, they should see a healthcare professional, especially if they are experiencing vision problems.