Preseptal cellulitis is a distinct disorder that explains an infection of the eyelid and superficial periorbital soft tissues, which do not involve the globe and orbit (10). One of the most common ocular diseases is a cellulitis in the orbital area, relatively. It can usually be treated effectively with antibiotics. Rapid diagnosis is very necessary, since a delay in detection, diagnosis and management can cause serious complications such as vision loss, cavernous sinus thrombosis, meningitis, and sepsis.
Preseptal cellulitis and orbital cellulitis can both present with increasing swelling, tenderness and redness around the eye, but their management differs. Preseptal cellulitis is more common and much less aggressive than orbital cellulitis (11). Preseptal cellulitis characterizes a cellulitis of the tissues localized anterior to the orbital septum. This distinction is important, as orbital cellulitis, while less common, may be associated with significant visual and life-threatening sequelae, including optic neuropathy, encephalomeningitis, cavernous sinus thrombosis, sepsis, and intracranial abscess formation (12).
In this study, we provided a systematic approach to distinguish preseptal cellulitis associated risk factors, which can be potentially lifesaving.
Another important sources of infection are contiguous spread of infection from the soft tissues of the face and ocular adnexa and could result from trauma, foreign bodies, insect bites, skin infections (impetigo), eyelid lesions (chalazia, hordeola), and iatrogenic causes such as eyelid and oral procedures (13).
Ferguson et al. (14) explained that a seasonal variation in orbital cellulitis was attributable to the increased incidence of upper respiratory tract infection and paranasal sinusitis in the same seasons of the year. In our pediatric patients who have orbital cellulitis, this inclination in winter was typically demonstrated. In addition, in other research, there were also smaller peaks in winter or spring, showed a seasonal preference of cellulitis in the orbital area.
Multiple factors can cause preseptal cellulitis, the following are common ones: having ocular trauma, paranasal sinusitis, upper respiratory tract infection, acute or chronic otitis, and dental origin (15, 16). Interestingly, in our series, the most common predisposing factors of preseptal cellulitis were trauma and sinusitis. Decaryocystitis and hordeolum were relatively minor factors. According to guidelines perceptual cellulitis due to sinusitis should be treated with antibitics active against S. pnemonia, H. influenza, and S. sureus. On the other hand, on case of perseptual cellulitis due to secondory infection of skin lesion antibiotics that are also active against group A streptococcus and S. aureus and sometimes MRSA. Especially in Staphylococcus and Streptococcus species, selection of antibiotic is completely directed towards causative agents of sinusitis and trauma, which can be considered as the predisposing factors of preseptal cellulitis (17).
In conclusion, preseptal cellulitis is more prevalent in age of 40; a seasonal preference of winter and spring has been explained in our patients. In our study, the most common predisposing factor was trauma, while other studies focus more on sinusitis factor.
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