Eyelid Infection or Cellulitis Infection

See which type of eyelid infection is affecting you and what you can do to reduce the symptoms it's causing.

Eyelid infections, also known as eyelid cellulitis, causes redness of the eyelids and the skin around the eye. In most cases, cellulitis is caused by bacteria, which may come from a skin injury, an insect bite on the eyelid, or from the sinuses.

Types of Eyelid Cellulitis

There are two types of eyelid cellulitis: preseptal cellulitis and orbital cellulitis. Below we will go over both—what they are, the differences between the two, and what causes each condition.

  • Preseptal Cellulitis: Preseptal cellulitis is a bacterial eyelid infection. It is the most common form of eyelid cellulitis, and it affects the skin around the eyeball that does not extend into the eye socket. It is caused by the spread of an infection due to local facial or eyelid trauma, insect or animal bites, conjunctivitis, chalazion, or sinusitis. It causes redness, tenderness, and swollen eyelids that make it difficult to open your eye. This type of cellulitis may turn the eyeball slightly red.  Preseptal cellulitis is more common in the pediatric population.  Patients with preseptal cellulitis tend to be younger than patients with orbital cellulitis.
  • Orbital Cellulitis: This form of eyelid cellulitis is much more severe than preseptal cellulitis. It occurs when the infection extends beyond the eyelid and into the back of the eye, close to the brain. In additional to the symptoms of preseptal cellulitis, it causes eye protrusion and double vision. Orbital cellulitis is caused by an infection in places such as the eyelid, teeth, sinuses, or face.

Medical research in the field of cellulitis has shown that individuals with particular risk factors are more prone to develop preseptal cellulitis. It is important that the patient understands the differences between the two types of eyelid cellulitis and what to watch for. This condition can turn from mild to severe quickly, so if you are unsure, or if you feel your symptoms are worsening you may want to contact an ophthalmologist immediately.

Eyelid Cellulitis Symptoms

Many of the symptoms of both types of cellulitis are similar and include:

  • Tenderness
  • Redness
  • Warmth
  • Swelling of entire eyelid
  • Soreness
  • Itching
  • Burning
  • Discharge or pus
  • Mild fever
  • Blurry vision
  • Watery eyes
  • Reduced vision
  • If orbital cellulitis is present, additional symptoms may include:
  • Eyelid pain and/or pain when moving eye
  • High fever
  • Headache
  • Bulging of the eye (proptosis)
  • Limited eye movement
  • Loss of vision

What Causes Eyelid Cellulitis?

Cellulitis is almost always caused by bacteria. There are several ways bacteria can enter your body, such as:

  • Injury to your skin such as cuts, insect bites, surgical wounds, etc.
  • Skin conditions such as eczema, psoriasis, fungal infections, ulcers, etc.
  • Weak immune system due to medical conditions such as diabetes
  • Edema (fluid build up) in arms or legs
  • Liposuction
  • Injecting illegal drugs

Diagnosing Eyelid Cellulitis

Do not wait to seek medical treatment if you are experiencing symptoms of cellulitis. To diagnose you, an eye doctor will perform a complete eye exam. After examining the eyes, he or she may order an imaging (CT) scan of your eye sockets and sinuses to determine the severity of the condition. Blood tests may also be ordered. Eye doctors will sometimes take samples from the lining of the eye and from the skin, throat, or sinuses, and send these along with the blood samples for testing in a laboratory. In the laboratory, the samples are cultured to determine the type of infection, where it is located, and how to treat it. Treatment will be based on the type of cellulitis diagnosed. Typically, antibiotic therapy is started before test results are known.

Treatment for Eyelid Cellulitis

Treatments include using warm compresses on the eyelid or face, avoiding touching or rubbing the eyes and eyelids, and relaxing until medical attention is available. Eyelid cellulitis is treated medically either with oral antibiotics or IV antibiotics, depending on the type of cellulitis. Typically, preseptal cellulitis is treated with oral antibiotics at first. Common choices include cephalexin, dicloxacillin,  clindamycin, and augmentin. If the infection is severe or if it occurs in a very young child, standard treatment involves admission into the hospital for antibiotics via IV. Patients may be placed under a continuous watch to ensure the infection does not spread. If a patient is suffering from orbital cellulitis, surgery may be necessary to decompress the orbit, drain an abscess, or open infected sinuses.

Prognosis of Eyelid Cellulitis

Symptoms of this condition usually disappear within a few days of receiving antibiotic treatment. Symptoms may worsen before they get better, however, as the bacteria die and substances that cause tissue damage are released. Although the bacteria are dead, the body continues to react. Antibiotics are often prescribed for ten days or longer, even though symptoms may disappear quickly.

Preventing Eyelid Cellulitis

Preventing both types of cellulitis may be as simple as getting a vaccination from your local health department. To prevent preseptal cellulitis ask for the haemophilus influenzae vaccine. For orbital cellulitis, ask for the HiB or hemophilus influenzae vaccine. Both vaccines are known to greatly reduce the risk of infection. There are also general prevention measures one can take to avoid spreading cellulitis, including:

  • Wear protective eyewear to protect the eyes from injury
  • Maintain good hygiene, especially when a cut or skin problem is present
  • Get treatment from your health care provider to prevent the spread of infection; take antibiotics
  • Have young children and infants vaccinated

Eyelid Cellulitis Complications

If cellulitis is left untreated it can lead to blindness. The infection can spread to the brain and spinal cord. Blood clots may develop and spread from the veins around the eye to the larger vein at the base of the brain called the cavernous sinus. If the infection spreads to that vein it can cause a condition called cavernous sinus thrombosis. Additional complications of both types of cellulitis include:

  • Hearing loss
  • Blood infection
  • Meningitis
  • Optic nerve damage

Talking to Your Eye Doctor 

  • Based on my symptoms, which type of cellulitis do you think I have?
  • What tests will be performed to diagnose me?
  • How long should it take for my symptoms to disappear?
  • Do I need to change my diet or lifestyle during treatment?
  • Will this condition recur? How often do you treat recurring cases?
  • Will I need to be hospitalized? How many days should I take off work?

 

References:
  • Donahue S, Schwartz G (1998). “Preseptal and orbital cellulitis in children. A changing microbiologic spectrum”. Ophthalmology 105 (10): 1902-5; discussion 1905-6
  • J. Weizer, MD; J. Stein, MD, MS “Reader’s Digest Guide to Eye Care” (Quantum Publishing, 2009) 55-56
  • M. Beers, MD “Merck Manual of Medical Information” second home edition (Pocket Books, 2003) 1220-1221; 1318
This article was last updated on 11/2013