Date of last review: Due to be updated

Differential diagnosis

  • Preseptal cellulitis
    • Hordeolum (external or internal)
    • Acute blepharitis
    • Insect bite or sting
    • Viral conjunctivitis with eyelid swelling
    • Allergic conjunctivitis with eyelid swelling
    • Angioneurotic oedema (if bilateral- could indicate severe systemic allergic reaction)
  • Orbital cellulitis
    • Cavernous sinus thrombosis
    • Mucormycosis (fungal infection)
    • Sarcoidosis
    • Dysthyroid exophthalmos
    • Neoplasia with inflammation
    • Acute allergic conjunctivitis

Possible management by Optometrist

Treatment

  • Orbital cellulitis-none
  • Pre-septal cellulitis- co manage with GP  adult patients who are systemically well 
    • POM Co-amoxiclav 500/125 mg every 8 hours for 7 days then review
    • If allergic to penicillin, then POM Erythromycin 500 mg 4 times a day for 5–7 days then review

Advice

  • Orbital cellulitis and paediatric pre-septal cellulitis- Emergency (same day) referral
  • Pre-septal cellulitis in adults 

Management Category

  • Emergency (same day) referral to ophthalmologist or A&E Department

Possible management by Ophthalmologist

  • Systemic antibiotics (parenteral and/or oral)
  • Drainage of orbital abscess