Synopsis
Distinguish superficial eyelid infection from postseptal disease, recognise a limited examination as a risk factor and arrange timely antibiotics, imaging and surgical review.
- Preseptal infection lies anterior to the orbital septum and should preserve ocular function.
- Orbital cellulitis affects deeper tissues and is a sight-threatening and potentially life-threatening infection.
- Normal acuity alone does not exclude early orbital disease.
Key red flags
Painful or restricted eye movements, binocular diplopia or proptosis.
Investigation priorities
Establish baseline function and detect deterioration during treatment.
Management branches
An orbital sign, serious illness or unreliable examination raises concern.
- Arrange urgent hospital assessment with ophthalmology, ENT and age-appropriate medical support.
- Start empirical intravenous treatment under the relevant orbital-infection protocol without waiting for scan results.
The patient is stable and the eye examination is reliably normal.
Key medicines
Co-amoxiclav for selected adult preseptal cellulitisNICE specifies 500 mg/125 mg orally three times daily for seven days for infection near the eyes or nose.
Ceftriaxone with metronidazole for adult orbital cellulitisThe cited Oxford protocol uses ceftriaxone 2 g intravenously once daily plus metronidazole 400 mg orally three times daily, with daily review and seven-to-fourteen-day total treatment.