The differentiation between preseptal and deep orbital cellulitis is difficult, based on clinical observation and clinical presentation may not always reflect the underlying disease severity. Subtle pathology may evolve into severe pathology very quickly. Joint ENT and Ophthalmology decision to proceed to CT scan, if impaired on eye examine or different or difficult to assess.
Preseptal and Orbital Cellulitis Management in Adults
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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.
Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.
If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.
Likely organisms: Staphycococcus aureus Streptococcus pneumoniae, H. influenzae, Moraxella catarrhalis, anaerobes
|Examination and Recommendation||Antibiotic Treatment|
|Proptosis is absent,
The following are unimpaired
Oral Co‐amoxiclav 625 mg
Likely organisms: Staphycococcus aureus Streptococcus pneumoniae, Streptococcus. pyogenes, Streptococcus milleri, H. influenzae,
Moraxella catarrhalis, anaerobes.
|Examination and Recommendations||Antibiotic Treatment|
Orbital Cellulitis Presentation
If MRSA discuss with microbiology
IV Clindamycin 600 mg 6 hourly