Date of last review: Due to be updated

Differential diagnosis

  • Facial cellulitis
  • Preseptal cellulitis
  • Orbital cellulitis
  • Acute frontal sinusitis
  • Infection following superficial trauma/abrasion of skin

Possible management by Optometrist

Treatment

  • Do not syringe or probe
  • Co-manage with GP patients with associated pre-septal cellulitis but 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

  • Hospital admission is required if patient is febrile and/or systemically unwell or if an abscess has developed (i.e. pointing on surface)

Management Category

  • Urgently refer (same day)
    • All children
    • Severe cases in adults
  • Refer within one week, milder cases not responsive to systemic antibiotic within 7 days
  • Chronic cases without inflammation
    • May respond to hot compresses/massage
    • Only require referral if recurrent episodes

Possible management by Ophthalmologist

  • Incision and drainage where appropriate
  • Systemic (including parenteral) antibiotics
  • Follow-up may include investigation and surgical intervention for nasolacrimal duct obstruction