Preseptal Cellulitis

Preseptal cellulitis (also called periorbital cellulitis) is an infection of the eyelid and the soft skin around the eye. The infection sits in front of a thin wall of tissue called the orbital septum. This wall separates the eyelid from the deeper “eye socket” (the orbit). Because the infection stays in front of this wall, it affects the eyelid but does not go into the eye socket. That is why people with preseptal cellulitis usually have a swollen, red, warm, and tender eyelid but do not have bulging of the eye, painful eye movements, or vision loss. Those deeper problems point to a different and more dangerous condition called orbital cellulitis. NCBI+1EyeWiki

Preseptal cellulitis is an infection of the eyelid skin and soft tissue in front of a thin wall called the orbital septum. Think of the septum as a safety wall that separates the eyelid (front) from the eye socket (back). In preseptal cellulitis, germs (usually bacteria) cause redness, warmth, swelling, and tenderness of the eyelid. The eye itself still moves normally, vision stays normal, and the eyeball does not bulge forward. This condition is common in children but can occur at any age. It often follows a scratch or small wound near the eye, a stye, insect bite, sinus infection, or skin infection nearby. With prompt antibiotics, most people recover quickly. Merck Manuals+1

The orbital septum works like a safety barrier. When germs stay in front of it, we call it preseptal cellulitis. When germs pass behind it, we call it orbital cellulitis. Orbital cellulitis can threaten sight and even life and often needs hospital care, scans, and IV antibiotics. Red flags for orbital cellulitis include eye movement pain or restriction, bulging eye (proptosis), double vision, decreased vision, or an abnormal pupil reaction. If any red flag is present, urgent imaging and specialist care are needed. NCBIRoyal Children’s Hospital

Preseptal cellulitis is a bacterial skin and soft-tissue infection of the eyelids and surrounding skin in front of the orbital septum. It most often follows sinus infections, minor skin injuries, insect bites, or styes, and it is most common in children, though adults can get it too. NCBIEyeWiki

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Types

Doctors do not use one single “official” list of types, but it helps to group cases by how they start, how severe they are, which germs are involved, and who is affected. Here are practical types, in plain English.

1. By source of infection

• From nearby areas: The infection spreads from a nearby problem such as sinusitis (especially the ethmoid or maxillary sinuses), dacryocystitis (infected tear sac), blepharitis (inflamed eyelid margins), or conjunctivitis that irritates the skin. Medscape

• From skin breaks: The infection follows a cut, scratch, acne lesion, piercing, or an insect bite on the eyelid or nearby facial skin. Germs enter through the small break. NCBI

• From bloodstream (rare): In small children who are not fully immunized, bacteria can travel through blood and seed the eyelid. This was more common before the Hib (Haemophilus influenzae type b) vaccine. Royal Children’s Hospital

2. By severity

• Mild: Red, warm, tender, puffy eyelid; the person feels okay or only a bit unwell; no pain with eye movement; no double vision; no bulging; vision normal.

• Moderate: More swelling and pain; may have low-grade fever; still no orbital red flags.

• Severe: Marked swelling, fever, or signs suggesting the infection might be spreading; needs urgent medical evaluation to rule out orbital disease.

3. By germ

• Common bacteria: Staphylococcus aureus (including MRSA in some communities), Streptococcus pyogenes, and Streptococcus pneumoniae are frequent causes. Animal or human bites raise concern for mixed bacteria including anaerobes. NCBIAAO

• H. influenzae: Now uncommon where Hib vaccination rates are high, but still possible in under-immunized children. Royal Children’s Hospital

• Other microbes (unusual): Certain viruses (e.g., varicella) can lead to secondary skin infection; fungal causes are rare and usually seen in people with serious immune problems. Medscape

4. By time course

• Acute: New infection developing over hours to a few days.

• Recurrent: Repeats in people with repeated sinus disease, chronic blepharitis, skin conditions, or nasolacrimal duct problems.

5. By setting

• Community-acquired: Most cases start at home/school/work.

• Healthcare-associated: Less common; may follow procedures or hospital care, and germs can be different.

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Causes

1. Acute sinusitis: Germs in the sinuses can spread into the eyelid skin, especially the ethmoid and maxillary sinuses that sit close to the eye. NCBI

2. Minor eyelid trauma: A small cut, scratch, or abrasion lets germs enter. NCBI

3. Insect bite: Bites cause tiny breaks and swelling; scratching adds more risk. NCBI

4. Hordeolum (stye): A blocked, infected eyelash gland can extend into nearby tissue. EyeWiki

5. Manipulated chalazion: Squeezing or poking a chalazion irritates skin and introduces bacteria.

6. Blepharitis: Chronically inflamed eyelid margins crack and allow bacteria to grow. Medscape

7. Dacryocystitis: An infected tear sac can spread infection to the eyelid. Medscape

8. Conjunctivitis with skin irritation: Constant rubbing and discharge can macerate skin.

9. Facial impetigo or cellulitis: Nearby skin infections can spill over to the eyelid.

10. Foreign body: Dust, plant material, or metal in the eyelid area can carry germs; rubbing worsens it.

11. Cosmetic or beauty procedures: Eyelid piercings, lash extensions, or microblading can cause small breaks or reactions that get infected if not sterile.

12. Dental or gum infection: Facial veins can allow spread from the mouth to adjacent tissues.

13. Animal or human bite/scratch: Mixed bacteria including anaerobes may be involved.

14. Atopic dermatitis or eczema: Itchy, cracked skin invites bacteria.

15. Recent upper respiratory infection: A viral cold can lead to bacterial sinusitis, which then spreads to the eyelid.

16. Poorly controlled diabetes: High sugar weakens defenses and helps bacteria grow.

17. Immune suppression: Chemotherapy, steroids, or illness reduce the body’s ability to fight infection.

18. Community MRSA exposure: Living in crowded settings or sharing sports gear can raise MRSA risk that then causes eyelid infection. AAO

19. Blood-borne spread in under-immunized child: Without Hib protection, bacteria can seed the eyelid from the blood. Royal Children’s Hospital

20. Post-nasal or sinus surgery complications: Procedures near the nose and sinuses sometimes allow germs to track to the eyelid.

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Symptoms

1. Eyelid swelling: The eyelid puffs up and may close the eye because of swelling. Medscape

2. Redness: The skin looks pink to deep red over the lid. EyeWiki

3. Warmth: The eyelid feels hotter than the nearby skin.

4. Tenderness or pain to touch: Light pressure hurts on the swollen lid.

5. Soreness around the eye: A dull, throbbing ache in the lid or brow area.

6. Mild fever: Many people feel a little hot or flushed; some have chills. EyeWiki

7. Feeling unwell: Tired, low energy, cranky child, or mild headache. EyeWiki

8. Tearing or watery eye: The eye waters because the lid is inflamed.

9. Irritation or gritty feeling: The eye may feel scratchy from lid swelling.

10. Crusting or discharge on lashes: Dried secretions stick the lashes.

11. Itching: Often from insect bites or eczema that got infected.

12. Sinus pressure or facial pain: If sinusitis started the problem.

13. Trouble opening the eye: Not from vision loss, but from heavy swelling. Medscape

14. Normal vision: People usually see normally; if vision drops, that is a warning sign for orbital disease. NCBI

15. No pain with eye movement: Eye movements are comfortable; if movements hurt, that is a red flag for orbital cellulitis. NCBI

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Diagnostic tests

Important: Doctors first use history and a careful exam to tell preseptal from orbital cellulitis. Tests help confirm the cause, look for complications, and rule out orbital disease.

A) Physical examination

1. Careful eyelid inspection: The doctor looks at color, swelling, breaks in the skin, styes, or bite marks. This helps find the source and shows how far the redness spreads. EyeWiki

2. Gentle palpation: The doctor feels for warmth, tenderness, and fluctuance (a soft, squishy spot) that can mean an abscess that may need drainage.

3. Visual acuity check: Reading letters (or age-appropriate symbols) shows if vision is normal. Vision drop suggests a deeper problem and needs urgent attention. NCBI

4. Eye movement (EOM) testing: The person looks in all directions. No pain and full movement support preseptal disease; pain or restricted movement suggests orbital cellulitis. NCBI

5. Pupil reaction test (RAPD check): A light is shined to see if pupils react normally. An abnormal response hints at optic nerve or orbital involvement and needs imaging. NCBI

B) “Manual” bedside checks

6. Eyelid eversion: The inner lid surface is gently flipped to look for a hidden foreign body, stye pointing inward, or pus pocket. This is quick and done at the slit lamp if available.

7. Lacrimal sac compression: Gentle press over the tear sac checks for dacryocystitis; pus from the punctum suggests a tear-drain problem feeding the infection. Medscape

8. Sinus tenderness and nasal exam: Light tapping over the sinuses and a front-of-nose look help find sinusitis as the source. NCBI

9. Fluorescein staining of the eye surface: A dye drop helps find corneal scratches or foreign bodies that may worsen irritation; it also checks that the eye surface itself is okay.

C) Laboratory and pathological tests

10. Complete blood count (CBC) with differential: Looks for raised white blood cells suggesting infection; severe elevation or very low counts can change decisions. emDocs

11. C-reactive protein (CRP) and/or ESR: These are inflammation markers. High levels support active infection and help track response to treatment. emDocs

12. Wound or discharge culture and Gram stain: If there is pus or drainage, a swab can identify the germ and show which antibiotics work best, including MRSA checks when suspected. AAO

13. Blood cultures: In very sick patients, in young or under-immunized children, or when fever is high, blood cultures look for bacteria in the blood. Royal Children’s Hospital

14. Blood glucose or HbA1c: Looks for diabetes that can worsen infection or slow healing; results also guide antibiotic and wound-care decisions.

D) Electrodiagnostic tests

These are not routine for preseptal cellulitis. They are considered only when vision is abnormal and the exam does not explain why.

15. Visual evoked potential (VEP): Measures the brain’s electrical response to visual signals to check optic nerve function when orbital disease is still a concern after imaging.

16. Electroretinogram (ERG): Measures retinal electrical activity; rarely used but can help exclude primary retinal disease if vision loss is present for another reason. (Again, these are uncommon in simple preseptal cellulitis.)

E) Imaging tests

17. CT scan of orbits and sinuses with contrast: The most common scan when orbital cellulitis is suspected. It can show abscesses, sinus disease, and whether infection is behind the septum. CT is quick and good in emergencies. Royal Children’s Hospital

18. MRI of orbits and brain: Used when there is concern for intracranial spread, cavernous sinus thrombosis, or when CT is unclear. MRI shows soft tissues very well but takes longer. Royal Children’s Hospital

19. Point-of-care ultrasound of the eyelid: A bedside ultrasound can help confirm a localized abscess in the eyelid and can sometimes help avoid a CT if orbital signs are absent.

20. Sinus imaging (as part of CT/MRI): Clarifies how much sinusitis is present and whether a sinus abscess or mucocele is part of the problem. This helps decide if ENT input or surgery is needed. Royal Children’s Hospital

Non-pharmacological treatments (therapies & other measures)

These support antibiotics; they do not replace antibiotics.

1. Warm compresses
   What: Clean, warm (not hot) compress on the closed eyelid for 5–10 minutes, 3–4 times daily.
   Purpose: Relieves pain, helps natural drainage, softens crusts.
   How it helps: Warmth increases blood flow, bringing immune cells and helping fluid move out. (General skin cellulitis care supports compresses.) Cleveland Clinic

2. Gentle eyelid cleansing
   What: Wipe crusts from lashes/skin with sterile saline or cooled boiled water; avoid harsh soaps and never scrub.
   Purpose: Reduces surface germs and debris.
   How: Mechanical cleaning lowers bacterial load without irritating the skin.

3. Head elevation
   What: Keep the head slightly raised when resting.
   Purpose: Reduces puffiness and pressure.
   How: Gravity improves venous/lymph drainage.

4. Adequate rest and sleep
   What: Aim for a full night’s sleep and light daytime rest.
   Purpose: Supports immune response.
   How: Sleep improves cytokine balance and immune cell function.

5. Hydration
   What: Drink water regularly; offer frequent small sips to children.
   Purpose: Keeps mucous membranes moist and supports circulation.
   How: Adequate fluids help immune cells reach infected tissue.

6. Do not wear contact lenses
   What: Stop contacts until full recovery.
   Purpose: Lowers risk of added irritation/infection.
   How: Contacts can trap bacteria and irritate lids.

7. No eye makeup or false lashes
   What: Pause mascara, eyeliner, lash glue; discard old products.
   Purpose: Reduces contamination and irritation.
   How: Eye cosmetics can harbor bacteria.

8. Hands-off rule
   What: Avoid rubbing or scratching the eye area; clip children’s nails.
   Purpose: Prevents new breaks in skin and spread of germs.
   How: Less mechanical trauma → fewer entry points for bacteria.

9. Frequent handwashing
   What: Soap and water 20 seconds; alcohol gel if needed.
   Purpose: Reduces transfer of bacteria to eyelids.
   How: Lowers contamination during drops/ointments application and daily care.

10. Clean pillowcases, towels, and glasses
    What: Change pillowcases often; don’t share towels; clean eyeglass frames.
    Purpose: Cuts re-exposure to germs.
    How: Removes bacteria from frequent-touch items.

11. Cool compress for throbbing swelling (short intervals)
    What: If warmth is uncomfortable, use a cool (not icy) compress 5–10 minutes.
    Purpose: Temporary swelling relief.
    How: Vasoconstriction reduces edema; alternate with warm compress if advised.

12. Nasal saline rinses for sinus symptoms
    What: Isotonic saline spray or rinse (age-appropriate).
    Purpose: Helps clear nasal mucus if sinusitis is present.
    How: Mechanical washout reduces bacterial burden and post-nasal drip (sinus disease is a common source). Merck Manuals

13. Wound care for any nearby skin breaks
    What: Wash minor cuts near the eye with clean water; apply simple dressing if needed.
    Purpose: Stops germs entering through new breaks.
    How: Clean skin and barrier dressing reduce bacterial entry.

14. Sun and glare protection
    What: Use sunglasses outdoors if light bothers the swollen lid.
    Purpose: Comfort and less rubbing.
    How: Reduces photophobia-triggered rubbing.

15. Allergen/irritant avoidance
    What: Avoid pool chemicals, smoke, dusty rooms during recovery.
    Purpose: Less eyelid irritation and scratching.
    How: Fewer triggers → less rubbing → less risk.

16. Blood sugar control (if diabetic)
    What: Follow your diabetes plan closely.
    Purpose: High glucose weakens immune function.
    How: Better glycemic control improves infection outcomes.

17. Safe outdoor play
    What: Protect against insect bites near the eyes (nets, long sleeves).
    Purpose: Prevents new inoculation points.
    How: Fewer bites → fewer bacteria entering skin.

18. Follow-up within 24–48 hours
    What: Recheck with the clinician if not clearly improving.
    Purpose: Ensures it isn’t becoming orbital cellulitis.
    How: Early review catches red flags quickly. Royal Children’s Hospital

19. Strict return/ER precautions
    What: Seek urgent care for pain with eye movement, double vision, vision drop, or bulging eye.
    Purpose: These are warning signs.
    How: Rapid hospital care prevents complications. Royal Children’s HospitalMerck Manuals

20. Vaccination up to date (especially children)
    What: Keep Hib and pneumococcal shots up to date.
    Purpose: Reduces some causes in children.
    How: Population data show far fewer Hib-related cases after vaccination. Merck Manuals

Drug treatments

Doses below are typical adult examples unless noted. Children’s doses are weight-based and must be set by a clinician. Duration varies by severity and source; many cases improve within 5–7 days (sometimes up to 7–10 days). Recheck if not clearly better in 24–48 hours. Local resistance patterns matter. idmp.ucsf.eduMerck Manuals

1. Amoxicillin–clavulanate (Augmentin)
   Class: Beta-lactam/beta-lactamase inhibitor.
   Dose/time: 875/125 mg by mouth every 12 hours (or 500/125 mg every 8 hours). Pediatric regimens commonly use ~45 mg/kg/dose of the amoxicillin part twice daily when sinus flora suspected.
   Purpose: First-line oral therapy when sinus germs or mixed flora are likely.
   Mechanism: Blocks bacterial cell-wall building and resists many beta-lactamases.
   Key side effects: Nausea/diarrhea, rash; rare liver enzyme elevations. idmp.ucsf.eduMerck Manuals

2. Cephalexin
   Class: First-generation cephalosporin.
   Dose/time: 500 mg by mouth every 6 hours (peds commonly 25 mg/kg/dose TID).
   Purpose: Covers staph (MSSA) and strep when skin flora suspected.
   Mechanism: Cell-wall synthesis inhibition.
   Side effects: GI upset, rash. idmp.ucsf.edu

3. Clindamycin (use when MRSA risk or severe penicillin allergy; local resistance varies)
   Class: Lincosamide.
   Dose/time: 300 mg by mouth every 6–8 hours (peds ~10 mg/kg/dose TID).
   Purpose: Covers MRSA in some regions and streptococci.
   Mechanism: Inhibits protein synthesis (50S subunit).
   Side effects: Diarrhea, risk of C. difficile. idmp.ucsf.eduMedscape

4. Trimethoprim–sulfamethoxazole (TMP–SMX)
   Class: Antifolate combination.
   Dose/time: 1 double-strength tablet (160/800 mg) by mouth every 12 hours; some adults require 2 DS tablets q12h.
   Purpose: MRSA coverage but weak vs Group A strep, so combine with amoxicillin when strep coverage is needed.
   Mechanism: Sequential folate pathway blockade.
   Side effects: Rash, photosensitivity, rare hyperkalemia. Merck Manuals

5. Doxycycline (age ≥8 years)
   Class: Tetracycline.
   Dose/time: 100 mg by mouth every 12 hours.
   Purpose: MRSA coverage in some regions (add amoxicillin for strep).
   Mechanism: Protein synthesis inhibition (30S).
   Side effects: Photosensitivity, esophagitis; avoid in pregnancy and in children under 8.

6. Cefuroxime axetil
   Class: Second-generation cephalosporin.
   Dose/time: 500 mg by mouth every 12 hours.
   Purpose: Good sinus flora coverage when sinusitis is the source.
   Mechanism: Cell-wall synthesis inhibition.
   Side effects: GI upset, rash. Merck Manuals

7. Ampicillin–sulbactam (Unasyn) – IV
   Class: Beta-lactam/beta-lactamase inhibitor.
   Dose/time: 1.5–3 g IV every 6 hours in adults (peds ~50 mg/kg ampicillin part q6h).
   Purpose: Inpatient therapy for moderate disease or poor oral intake.
   Mechanism: Cell-wall inhibition plus beta-lactamase block.
   Side effects: Rash, diarrhea. idmp.ucsf.eduMerck Manuals

8. Ceftriaxone – IV
   Class: Third-generation cephalosporin.
   Dose/time: 1–2 g IV daily (adults).
   Purpose: Broad gram-negative/streptococcal coverage when hospitalized.
   Mechanism: Cell-wall inhibition.
   Side effects: Biliary sludging (rare), GI upset. Merck Manuals

9. Vancomycin – IV (for suspected/confirmed MRSA in inpatients)
   Class: Glycopeptide.
   Dose/time: ~15–20 mg/kg IV every 8–12 hours (individualized by levels/kidney function).
   Purpose: Serious MRSA coverage.
   Mechanism: Cell-wall cross-link blockade.
   Side effects: Kidney toxicity risk, “red man” flushing if infused fast. Merck Manuals

10. Linezolid (reserved)
    Class: Oxazolidinone.
    Dose/time: 600 mg by mouth or IV every 12 hours.
    Purpose: Alternative for resistant gram-positive infections when others are unsuitable.
    Mechanism: Blocks initiation of protein synthesis.
    Side effects: Cytopenias with prolonged use, SSRI interaction risk. Medscape

Typical duration & follow-up: Many uncomplicated cases are treated 5–7 days, longer if sinusitis is driving the infection or if response is slow. Clinicians reassess within 24–48 hours to ensure it isn’t evolving into orbital cellulitis. idmp.ucsf.eduRoyal Children’s Hospital

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Dietary molecular supplements

Always discuss supplements with your clinician. They can interact with antibiotics or other medicines. These are supportive; they do not kill the bacteria causing preseptal cellulitis.

1. Vitamin D3 (1,000–2,000 IU/day)
   Function: Immune modulation; supports innate and adaptive responses.
   Mechanism: Vitamin D receptor signaling in immune cells.

2. Vitamin C (500 mg twice daily)
   Function: Antioxidant; supports neutrophil function and collagen repair.
   Mechanism: Redox support; cofactor in collagen synthesis.

3. Zinc (15–30 mg elemental/day; take away from doxycycline/quinolones)
   Function: Supports barrier healing and innate immunity.
   Mechanism: Cofactor for many enzymes in immune cells.

4. Omega-3 fatty acids (EPA+DHA) (1–2 g/day total)
   Function: Calm excessive inflammation and support healing.
   Mechanism: Resolvin/protectin pathways.

5. Probiotics (e.g., Lactobacillus/Bifidobacterium) (per label)
   Function: May reduce antibiotic-associated diarrhea; supports gut barrier.
   Mechanism: Microbiome modulation; short-chain fatty acid production.

6. Curcumin (≈500 mg twice daily with piperine; avoid with anticoagulants unless approved)
   Function: Anti-inflammatory adjunct.
   Mechanism: NF-κB pathway modulation.

7. Quercetin (≈500 mg twice daily)
   Function: Antioxidant/anti-inflammatory flavonoid.
   Mechanism: Mast-cell and cytokine modulation.

8. Selenium (≈100 mcg/day; do not exceed 200 mcg/day chronically)
   Function: Antioxidant enzyme support (glutathione peroxidase).
   Mechanism: Redox balance aiding immune cell function.

9. Vitamin A (2,500–5,000 IU/day short-term; avoid excess and avoid in pregnancy unless prescribed)
   Function: Epithelial health and mucosal immunity.
   Mechanism: Retinoic-acid–mediated gene expression.

10. Lactoferrin (≈200–300 mg/day)
    Function: Iron-binding glycoprotein with antimicrobial properties in vitro.
    Mechanism: Sequesters iron, modulates immune signaling.

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Regenerative / Stem-cell drugs

Important safety note: There are no approved “hard immunity boosters,” regenerative drugs, or stem-cell treatments for preseptal cellulitis. Using such treatments for this condition is not evidence-based and may be harmful. The proven treatment is appropriate antibiotics, plus the supportive measures above, with urgent escalation if orbital warning signs appear. Merck Manuals

If a patient has special immune problems, specialists sometimes use immune-supportive therapies for the underlying condition (not as a treatment for preseptal cellulitis itself). Examples—strictly under specialist care:

1. Filgrastim (G-CSF): For severe neutropenia only; typical adult dosing around 5 mcg/kg/day SC until ANC recovers. Function: raises neutrophil count. Mechanism: stimulates marrow neutrophil production.

2. Intravenous immunoglobulin (IVIG): For certain antibody deficiencies; dosing varies (e.g., 0.4 g/kg/day × 5 days or periodic replacement). Function: provides protective antibodies. Mechanism: passive immunity.
   3–6) No other immune “boosters,” stem-cell products, exosomes, or biologics are recommended for preseptal cellulitis; do not use outside a clinical trial and outside a condition-specific indication set by a specialist.

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Procedures/surgeries

Most people with preseptal cellulitis do not need surgery. Procedures are reserved for complications or an underlying source:

1. Incision and drainage of an eyelid abscess
   What: A small cut to drain pus.
   Why: If a localized lid abscess forms or a large, fluctuant stye turns into an abscess that antibiotics cannot clear.

2. Drainage of a large or persistent stye/chalazion
   What: Minor office procedure under local anesthesia.
   Why: Removes the pus core if it is the continuing infection focus.

3. Management of infected nasolacrimal duct disease (e.g., dacryocystitis)
   What: Procedures such as dacryocystorhinostomy (DCR) in recurrent cases.
   Why: Opens the tear drainage pathway to stop repeated infections.

4. Sinus surgery (FESS) for chronic/refractory sinusitis sources
   What: Functional endoscopic sinus surgery.
   Why: Clears blocked infected sinuses that keep seeding the eyelid.

5. Urgent debridement in rare necrotizing soft-tissue infection
   What: Surgical removal of dead tissue.
   Why: Life- and sight-saving in the extremely rare event of necrotizing periocular infection (more typical of orbital/soft-tissue emergencies, not routine preseptal cellulitis). Merck Manuals

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Preventions

1. Treat styes and eyelid infections early to stop spread into the lid skin.

2. Keep vaccinations up to date (children: Hib and pneumococcal). Merck Manuals

3. Good hand hygiene before touching the eye area or applying drops/ointments.

4. Avoid rubbing eyes; keep nails trimmed, especially in kids.

5. Manage sinus problems promptly (saline rinses, medical review).

6. Protect the eye area during sports and yard work to prevent cuts/foreign bodies.

7. Insect bite care: wash and avoid scratching bites near the eye.

8. Do not share makeup or towels; replace old eye cosmetics.

9. Control chronic illnesses (e.g., diabetes) to help the immune system.

10. Seek medical care early if eyelid swelling is worsening or if a fever appears.

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When to see a doctor

• See a doctor the same day for any new eyelid swelling, redness, warmth, or tenderness, especially in a child.

• Go to the emergency department now if you notice pain with eye movements, double vision, decreased or blurry vision, the eye looks pushed forward (bulging), very high fever, severe headache, or the child seems very unwell. These are orbital cellulitis red flags and can be dangerous if not treated urgently. Royal Children’s HospitalMerck Manuals

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What to eat” and “what to avoid

1. Eat: Protein-rich foods (eggs, fish, lentils, tofu) to support tissue repair.

2. Eat: Colorful fruits/vegetables (berries, citrus, leafy greens) for vitamin C and antioxidants.

3. Eat: Foods with zinc (beans, nuts, seeds) for skin healing.

4. Eat: Whole grains for steady energy.

5. Drink: Plenty of water; warm soups are good if appetite is low.

6. Avoid: Alcohol, which can worsen dehydration and interact with some antibiotics.

7. Avoid: Very sugary foods/drinks, especially if you have diabetes, because high glucose slows healing.

8. Avoid: Grapefruit with certain antibiotics (not common first-line here, but a safe general rule).

9. Avoid: Calcium/iron at the same time as doxycycline—they bind the drug; take them several hours apart if doxycycline is prescribed.

10. Avoid: Unpasteurized/unsafe foods if you are otherwise immunocompromised (general infection safety).

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Frequently asked questions (FAQs)

1. Is preseptal cellulitis contagious?
   No. The condition itself is not contagious, but the bacteria that caused it can live on skin and surfaces. Good hand hygiene protects others.

2. How is it different from orbital cellulitis?
   Preseptal cellulitis is in front of the orbital septum (eyelid only); orbital cellulitis is behind the septum and threatens vision. Pain with eye movement, double vision, bulging eye, and vision changes suggest orbital disease—get urgent care. Royal Children’s HospitalMerck Manuals

3. Do I always need antibiotics?
   Yes—this is a bacterial skin infection of the eyelid. Home remedies alone are not enough. Cleveland Clinic

4. How fast should I feel better?
   Many people start to feel better within 24–48 hours; swelling may look worse before it looks better. If no clear improvement in 48 hours, call your clinician. Royal Children’s Hospital

5. Will I lose vision?
   Not from preseptal cellulitis if it stays in front of the septum. Vision loss risk rises if it progresses to orbital cellulitis, which is why red-flag symptoms need urgent care. Merck Manuals

6. Do I need a CT or MRI?
   Not usually for straightforward preseptal cellulitis. Imaging is done if the exam is hard (e.g., a very swollen child), symptoms are severe, or orbital cellulitis is suspected. Merck Manuals

7. Can I use steroid drops or creams?
   No over-the-counter steroid creams near the eye. They can worsen infection or thin the skin. Use only what your clinician prescribes.

8. Can I keep wearing contact lenses?
   No. Stop contacts until fully recovered to reduce irritation and bacterial contamination.

9. Do I need cultures?
   Usually no for simple cases. Cultures are considered if there is discharge to sample, severe disease, or poor response to treatment. Merck Manuals

10. Which antibiotic is best?
    Doctors choose based on likely source (skin vs sinus), allergy history, local resistance, and age. Options commonly include amoxicillin–clavulanate, cephalexin, clindamycin, or TMP–SMX plus amoxicillin when MRSA risk exists. Hospital cases may need IV medicines. idmp.ucsf.eduMerck Manuals

11. How long do I take antibiotics?
    Often 5–7 days, sometimes longer (e.g., if sinusitis is the source). Always finish the prescribed course unless your clinician changes it. idmp.ucsf.edu

12. My child looks worse after the first day—is that normal?
    Swelling sometimes looks worse in the first 24 hours. The key is overall progress over 48 hours. If worse or red-flag symptoms appear, seek care. Royal Children’s Hospital

13. Can I treat this at home?
    Yes, mild cases can often be treated at home with oral antibiotics, warm compresses, and close follow-up—as long as orbital cellulitis has been ruled out. Merck Manuals

14. What causes preseptal cellulitis?
    Common sources are small skin breaks, styes/chalazia, insect bites, and sinus infections spreading to the eyelid. Merck Manuals

15. How can I prevent it from coming back?
    Good hand and eyelid hygiene, early treatment of styes and sinus infections, replacing old makeup, protecting the eye area from injuries, and keeping vaccines current in children all help. Merck Manuals

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The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 22, 2025.