At a Glance - Orbital cellulitis vs periorbital


  • Infection of the orbital soft tissues.
  • Usually caused by extension of sinusitis.
  • Affects older children (average, 12 years).
  • Protrusion of the eyeball.
  • Eyelids shiny and red or purple.
  • Swollen lid impairs vision.
  • Chemosis.
  • Decreased visual acuity.
  • Eye movements restricted and painful.
  • Fever.
  • Systemically unwell.


  • Sight and life threatening.
  • Refer for intravenous antibiotics.
  • May require surgery.



  • Affects the eyelids and periorbital soft tissues, but not the orbit of the eye.
  • Caused by trauma to the eyelids, including insect bites, or bacteraemia.
  • Eyelids red and swollen; warm and tender.
  • Rarely progress to orbital cellulitis.
  • Constitutionally well.- Vision tends to be ok.
  • No protrusion of the eyeball.
  • Affects younger children (average, 21 months)


  • Usually managed medically.

Contributed by Dr Vasa Gnanapragasam, a GP in Sutton, Surrey.

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