Objective: To describe causes of preseptal cellulitis (PSC) and outcome of treatment in patients admitted to a tertiary eye-care center.
Methods: A 15-year (January 1991 – December 2005) review of in-patients with clinical signs and symptoms or radiologic evidence suggestive of PSC was conducted. Patients with infection anterior to the orbital septum which is characterized by acute onset of eyelid edema, tenderness, erythema, warmth and chemosis were included in the study.
Results: Among the 104 patients (Male:female 64:40) fulfilling the diagnostic criteria for PSC, acute dacryocystitis (ADC) was the most common predisposing cause in 32.6% patients, followed by sinusitis/upper respiratory infection (URI) in 28.8% and trauma/recent surgery in 27.8% patients. Fifty-percent required surgical intervention including dacryocystorhinostomy/probing/stenting in 74% and abscess/chalazian drainage in 28.8%. In 38.5% of the patients who had surgical intervention, microbiological investigations were carried out, cultures were positive in 90%. Most common microorganisms recovered included Staphylococcus and Streptococcus species followed by Haemophilus influenzae and Klebsiella pneumonia. Blood cultures were positive in 2 of the 34 patients in whom blood was drawn. Most patients responded to systemic antibiotics with resolution of PSC. Seven patients developed late complications which included subacute lid abscesses, eyelid necrosis and cicatricial ectropion.
Conclusions: Sinusitis/URI, ADC and recent history of trauma/ surgery were the most common cause of PSC in admitted patients. Although most patients responded to systemic antibiotics, surgical intervention was necessary in some patients to prevent associated complications.