Preseptal and Orbital Cellulitis Overview

Pre-septal Cellulitis

• Common infection of eyelid and periorbital soft tissues
• Primarily affects children (80% under 10, mostly under 5)
• Symptoms may include fever, tiredness, and irritability
• Septal barrier prevents infection from spreading to the orbit
• Often preceded by upper respiratory tract infections (e.g., sinusitis)
• Causative organisms include Staphylococcus aureus, Staphylococcus epidermidis, streptococci, and anaerobes
• Symptoms include acute pain, swollen eyelid, redness, blurred vision, conjunctivitis, and tearing.

Bacterial Orbital Cellulitis

• Infection of tissues posterior to the septum
• Usually caused by spread from an adjacent sinus (most common is ethmoid sinus)
• Can also spread from dacrocystitis (tear duct infection) or trauma/surgery
• Causative organisms include Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, and Beta-hemolytic streptococci
• Symptoms include pain with eye movement, conjunctival swelling, proptosis (bulging eye), ophthalmoplegia (eye muscle weakness), restricted eye movements, decreased vision (due to optic nerve compression), and systemic symptoms like fever and malaise.

Management

• Confirmation of diagnosis crucial
• Treatment of underlying conditions
• Aggressive systemic antibiotics commonly used
• In younger children/severe cases, IV antibiotics may be necessary
• Failure to respond to antibiotics requires further investigation (e.g., CT scan of the orbit and sinuses, pus drainage)

Tumors - Basal Cell Carcinoma

• Accounts for 80-90% of eyelid cancers
• Slow-growing and destructive
• Locally invasive
• Classic presentation is a non-healing ulcer with pearly white borders
• Stems from the basal layer of the skin
• Most common in light-skinned individuals with high UV exposure
• Increased incidence with age; peaks in the 70s
• Often presents as a nodular, ulcerative, or morpheic lesion
• Requires surgical removal and potentially skin grafting if large

Tumors - Squamous Cell Carcinoma

• Rare compared to basal cell carcinoma
• More aggressive than basal cell carcinoma
• Second most common eyelid malignancy (about 5%)
• Usually in the elderly
• Often linked to chronic sun exposure and pre-cancerous lesions (actinic keratosis, Bowen's disease)
• Higher risk for immunocompromised individuals
• Surgical removal is common management

Benign Eyelid Lesions

• Cysts from eyelid glands (e.g., Meibomian, Zeis)
• Molloscum contagiosum: contagious benign skin lesions, dome-shaped, waxy lesions, spread through direct contact
• Treatment is often cosmetic

Thyroid Eye Disease

• Primarily affects women in their 40s to 60s
• Associated with Graves' disease (autoimmune condition)
• Symptoms may involve systemic issues (tremor, weight loss, etc.) and prominent eye changes (proptosis, lid retraction, irritation due to corneal dryness etc.)
• Severe cases involve optic nerve compression, leading to vision loss.