Clinical features of preseptal and orbital cellulitis

Clinical feature	Preseptal cellulitis	Orbital cellulitis
Eyelid swelling with or without erythema	Yes	Yes
Eye pain/tenderness	May be present	Yes; may cause deep eye pain
Pain with eye movements	No	Yes
Proptosis	No	Usually, but may be subtle
Ophthalmoplegia +/- diplopia	No	May be present
Vision impairment	No	May be present*
Chemosis	Rarely present	May be present
Fever	May be present	Usually present
Leukocytosis	May be present	May be present

* An afferent pupillary defect may signal impending visual loss.

References:

Seltz LB, Smith J, Durairaj VD, et al. Microbiology and antibiotic management of orbital cellulitis. Pediatrics 2011; 127:e566.
Durand ML. Periocular infections. In: Principles and Practice of Infectious Diseases, 7th ed, Mandell GL, Bennett, et al. (Eds), Churchill Livingstone Elsevier, Philadelphia 2010. p.1569.
Chaudhry IA, Shamsi FA, Elzaridi E, et al. Inpatient preseptal cellulitis: experience from a tertiary eye care centre. Br J Ophthalmol 2008; 92:1337.
Botting AM, McIntosh D, Mahadevan M. Paediatric pre- and post-septal peri-orbital infections are different diseases. A retrospective review of 262 cases. Int J Pediatr Otorhinolaryngol 2008; 72:377.
Nageswaran S, Woods CR, Benjamin DK Jr, et al. Orbital cellulitis in children. Pediatr Infect Dis J 2006; 25:695.
Sobol SE, Marchand J, Tewfik TL, et al. Orbital complications of sinusitis in children. J Otolaryngol 2002; 31:131.
Givner LB. Periorbital versus orbital cellulitis. Pediatr Infect Dis J 2002; 21:1157.

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