[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Preseptal (periorbital) cellulitis # Preseptal (periorbital) cellulitis An eyelid infection in front of the orbital septum: a red, swollen lid with normal vision and eye movements, treated with oral antibiotics and close review. Updated Nov 5, 2026 ## Quick facts **Key signs** Red · Difficulty opening the eye because **Diagnosis** Clinical Red flags ↓ No doses: the clinician sets them by the current guideline. On this page - The basics What it is - Who gets it - Causes - Risk factors - Pathophysiology - Why it happens - In ENT - Clinical Symptoms and signs - Red flags - Diagnosis - Differential diagnosis - Complications - Prognosis - Treatment Goal of treatment - Treatment - Prevention - Study Test yourself - Connections Connections ## What it is A bacterial infection of the eyelid and periorbital soft tissues in front of the orbital septum. It is much more common and less dangerous than orbital cellulitis, from which it must be told apart: in preseptal cellulitis vision, pupils and eye movements are normal and there is no proptosis. See it in 3D - [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/) - [Orbicularis oculi](https://durgical.com/en/anatomy/orbital-part-of-orbicularis-oculi/) - [Tear drainage](https://durgical.com/en/anatomy/lacrimal-canaliculus/) ## Who gets it Most common in children under 5, often after a [skin](https://durgical.com/en/anatomy/skin/) injury, insect bite, stye or upper respiratory infection. ## Causes - Skin breaks: insect bites, scratches, wounds - Spread from a stye, chalazion or dacryocystitis - Spread from sinusitis or a respiratory infection - Staphylococci and streptococci are the usual bacteria ## Risk factors - Young age - Recent eyelid trauma or bite - Sinusitis - Lid infections - Incomplete vaccination (Haemophilus influenzae type b) ## Pathophysiology Bacteria enter the lid tissues through the skin or from neighbouring infections. The orbital septum, a fibrous sheet from the orbital rim to the tarsus, keeps the infection out of the orbit, so the eye itself and its muscles remain unaffected. ## Symptoms and signs - Red, warm, swollen and tender eyelid - Difficulty opening the eye because of swelling - Mild fever in some children - Normal vision and painless eye movements ## Red flags - Proptosis, painful or restricted eye movements, reduced vision or an afferent pupillary defect: orbital cellulitis - High fever, toxic appearance or age under one year - No improvement after 24 to 48 hours of antibiotics - Headache, vomiting or altered consciousness ## Diagnosis **Clinical** Clinical diagnosis. The key is to check vision, pupils, eye movements and the position of the eye; opening the swollen lid may need help in children. **Tests** Blood tests and cultures in unwell children; culture of any discharge. **Imaging** Contrast CT of the orbits and sinuses if orbital involvement cannot be excluded clinically or there is no improvement. ## Differential diagnosis - Orbital cellulitis - Allergic lid swelling (itchy, not tender) - Insect bite reaction - Dacryocystitis - Chalazion or stye ## Goal of treatment Cure the infection and detect any spread to the orbit early. ## Treatment **Medical** Oral antibiotics active against staphylococci and streptococci, with review within 24 to 48 hours. **Acute** Admission and intravenous antibiotics for young infants, unwell children or failure of oral treatment. **Conservative** Warm compresses and treatment of the source (stye, bite, sinusitis). ## Complications - Spread to the orbit (orbital cellulitis) - Lid abscess - Rarely, [cavernous sinus](https://durgical.com/en/anatomy/cavernous-sinus/) thrombosis or meningitis if it progresses ## Prognosis Excellent with timely treatment. ## Prevention - Complete Haemophilus influenzae type b vaccination - Early treatment of lid infections and sinusitis ## Test yourself Think of the answer, then tap the question to see it. ## Which findings are normal in preseptal but not in orbital cellulitis? Vision, pupils, eye movements and eye position (no proptosis). ## What structure keeps preseptal cellulitis out of the orbit? The orbital septum. ## When is imaging needed in periorbital swelling? When orbital involvement cannot be excluded clinically or there is no improvement on treatment. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/conditions/preseptal-cellulitis/) ## Why it happens - [Orbital disease](https://durgical.com/en/general-pathology/orbital-disease/) ## In ENT - [Complications of sinusitis: orbital, intracranial and bony](https://durgical.com/en/ent/complications-of-sinusitis-orbital-intracranial-and-bony/) ## Connections ## Related conditions 4 - [Orbital cellulitis](https://durgical.com/en/conditions/orbital-cellulitis/) - [Chalazion and hordeolum (stye)](https://durgical.com/en/conditions/chalazion-and-hordeolum/) - [Dacryocystitis and nasolacrimal duct obstruction](https://durgical.com/en/conditions/dacryocystitis-and-nasolacrimal-duct-obstruction/) - [Acute rhinosinusitis](https://durgical.com/en/conditions/acute-rhinosinusitis/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Periorbital Cellulitis](https://www.ncbi.nlm.nih.gov/books/NBK470408/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Orbital Cellulitis](https://www.ncbi.nlm.nih.gov/books/NBK507901/) (StatPearls Publishing (NCBI Bookshelf), 2026). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/preseptal-cellulitis/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/preseptal-cellulitis/