11.3 Periocular infections (Eyelid infections, Orbital cellulitis)
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Periorbital/preseptal cellulitis | Oral Amoxicillin with clavulanic acid 90/6.4 mg /kg/day BID If age < 2 years: 10 days If age > 2 years: 5-7 days Or Oral cotrimoxazole 5 mg/kg per day for 5 to 7 days Systemic antibiotic therapy is administered for 5 to 7 days but may be extended if cellulitis persists. | Clindamycin (10mg/kg/dose {max 600 mg/dose}) with ciprofloxacin (Oral) 500 mg BD for 5 to 7 days or until resolution of inflammation | |
| Uncomplicated orbital cellulitis | Oral antibiotics to be considered: First-line: Amoxicillin- clavulanate (IV) Or IV Ceftriaxone. If > 7 years add clindamycin / metronidazole (500mg q8h for adults and 30 mg/kg per day in divided doses for children) along with Ceftriaxone. MRSA or an at-risk population: Clindamycin should be considered as initial treatment. Children over 40kg: Give adult dosage. Analgesics such as NSAIDs and Paracetamol to be used. | Clindamycin 300mg q8h Or Trimethoprim- Sulfamethoxazole 1-2 DS tab BD Alternative: Ciprofloxacin If no intracranial involvement switch to oral Amoxicillin with clavulanic acid or clindamycin + ciprofloxacin | Periorbital cellulitis is an infection of the eyelid or skin around the eye. Common microorganisms: Streptococcus pneumoniae, Hemophilus influenzae, Staphylococcus aureus, Gram Negative bacilli post trauma. Antibiotic therapy ranges from a total of at least 2 to 4 weeks. Surgery may be needed to drain the abscess or relieve pressure in the space around the eye. |
| Complicated (With intracranial extension) | Vancomycin 15 to 20 mg/kg per day IV every 8 to 12 hours + Ceftriaxone 2 g IV per 12hrs Duration: at least 2 to 3 weeks or until the resolution of inflammation. Clindamycin 15mg/kg (max 600 mg) IV/oral 8 hrly x 7-10 days Or Tab Cotrimoxazole (8/40mg/ml) 4.20 mg/kg (max 320/1600mg) BD x 7-10 days | Surgery is almost always indicated in patients with intracranial extension of the infection. |
For common etiological agents of Periocular infections (Eyelid infections, Orbital cellulitis), see Annexure B.11.3
Additional Information
- Aspergillusinfection of the orbit occurs in patients with severe neutropenia or other immune deficiencies, such as HIV infection.
References
1. A.A. Gordon and P.O. Phelps, Management of pre-septal and orbital cellulitis for the primary care physician, Disease-a-Month, https://doi.org/10.1016/j.disamonth.2020.101044
2. Kanski’s clinical ophthalmology, a systemic approach 10th edition, pg 124,125