Periorbital Cellulitis CA4024v3
Periorbital Cellulitis CA4024v3
Periorbital Cellulitis CA4024v3
A Clinical Guideline
For use in: Jenny Lind Paediatric Department
By: Jenny Lind Paediatric Department
Children (1 month - 16 years) presenting with the
For:
symptoms and signs of periorbital cellulitis
Divisions responsible for
Divisions 2 and 3
document:
Key words: Cellulitis; Periorbital; Children
Dr Dipali Shah (ST7 Paediatrics)
Names and job titles
of document authors:
Dr Vipan Datta (Consultant Paediatrician)
Name of document author’s
David Booth
Line Manager:
Job title of author’s Line
Chief of Women’s and Children’s Services
Manager:
Mr Puvanachandra (Consultant Ophthalmologist)
This guideline has been approved by the Trust's Clinical Guidelines Assessment Panel as an aid to the diagnosis and management of
relevant patients and clinical circumstances. Not every patient or situation fits neatly into a standard guideline scenario and the guideline
must be interpreted and applied in practice in the light of prevailing clinical circumstances, the diagnostic and treatment options available
and the professional judgement, knowledge and expertise of relevant clinicians. It is advised that the rationale for any departure from
relevant guidance should be documented in the patient's case notes.
The Trust's guidelines are made publicly available as part of the collective endeavour to continuously improve the quality of healthcare
through sharing medical experience and knowledge. The Trust accepts no responsibility for any misunderstanding or misapplication of this
document.
PERIORBITAL
OEDEMA/ERYTHEMA AND ONE
PERIORBITAL OR MORE OF:
OEDEMA/ERYTHEMA ONLY Proptosis†, chemosis, pain on eye
AND 3 YEARS OLD OR OVER movement, pyrexial ≥380C,
<3 years old, altered vision†,
decreased eye movements†,
bilateral oedema†
Upper lid only affected
White eye with full range of
normal eye movements
Admit under paediatrics & seek early ENT,
Ophthalmology opinion
(ophthalmology to r/v within 2 hours of CAU
admission)
Oral co-amoxiclav 7days IV Ceftriaxone (within one hour of decision) and oral
Home with open access Metronidazole after FBC,CRP,blood cultures and if
< 12 months or possible meningitis consider LP, R/V
by Paeds, Oph, ENT at 4-12 hr (depending upon
severity) and 24, 48 hrs
Review 24 and 48
hours
2 Rationale
Periorbital cellulitis (the infection of the soft tissues surrounding the eye) is a fairly common
presenting problem in the Children’s Assessment Unit, and is most commonly seen in
childhood. Whilst most cases resolve uneventfully with treatment, a small proportion of
patients may go on to develop potentially serious complications – e.g. blindness or brain
abscess.1 We would, however, also wish to avoid unnecessary admissions to the ward.
Imaging plays an important role in the management of the condition. CT scan can be a
very useful investigation, but due to the time, cost, and high doses of radiation involved it
is not suitable for every patient.
The guideline assumes that patients will be seen by a paediatric doctor in the first
instance. It therefore aims to give assistance in helping staff to determine which patients
need admission, which teams to involve and when, and in making the difficult decision of
when to, or not to, perform a CT scan.
Antibiotics
In case of penicillin allergy, oral co-amoxiclav may be substituted by oral cefradine and
oral clarithromycin together as follows: