Treatment for preseptal and orbital cellulitis involves antibiotic therapy, management of predisposing conditions and close observation. Initial antibiotic therapy is empiric. In most cases, it is very difficult to identify a pathogen. After considering the predisposing factors, antibiotics should be administered. It should be directed towards organisms that cause upper respiratory tract infections, especially sinusitis.
Specific organisms include Moraxella catarrhalis, nontypeable H influenzae and Sreptococcus pneumoniae. Treatment should include coverage for S aureus in cases due to focal trauma. The general treatment includes:
- In adults, outpatient treatment may be considered with a cephalosporin or clavulanic/amoxicillin acid. Also outpatient management with intramuscular ceftrixone is feasible. You should consider intravenous antibiotics if within 48-72 hours the patient fails to yield positive results.
- In more severe cases or in younger children, administering intravenous antibiotics and close observation is a standard procedure. Cephalosporin (ceftrixone, cefuroxiame) is effective, even with a resistant S pneumoniae. Clindamycin with a cephalosporin provides effective coverage if anaerobes or S aureus are suspected.
- Other primary antibiotics include penicillinase resistant synthetic penicillins like oxacillin and nafcillin. It is effective against S aureus.
- Within 24-48 hours, clinical improvement should be seen. A trial of oral antibiotics for 24 hours can be tried after clinical improvement on 48-72 hours of intravenous antibiotics is successfully demonstrated.
- The patient can be observed on an outpatient basis if continual clinical improvement is seen. Oral antibiotics should be continued for 10 days.
Surgery may be required to treat these eye infections. It is generally done to drain an abscess, decompress the orbit and open infected sinuses. Surgery is done for any of the following circumstances:
- detecting a foreign body or suppuration
- vision is compromised
- persistent infection even after antibiotic therapy
- imaging shows large or orbital subperiosteal abscess
