The paper addresses two similar forms of orbital infections, periorbital, also known as preseptal infections and orbital infections. The two infections have several similar symptoms and signs making it challenging for practitioners to differentiate them. Periorbital is less dangerous whereas orbital cellulitis is vision damaging thus more attention is needed when diagnosing. The paper uses a case study to assess the patient diagnosis by carrying out the drug treatment given and the signs and symptoms recorded. The reasons why the medications were issued are also to be explained.

Diagnosing the patient with the correct condition or illness is primary to improving their health as it determines what drugs are issued to the treat the illness. Some of the diseases relate to symptoms, causes, and the area affected posing challenges to practitioners. The paper will carry out a diagnosis a patient using the antibiotic treatment plan applied to the patient under the Australian guidelines for pharmaceutical treatment taking into concepts the appropriateness of the drugs and doses issued. The reasons for the issuing of the medications and other effects, either positive or negative they could have on the patients will also be discussed.

Periorbital cellulitis, also known as preseptal cellulitis and Orbital cellulitis pose similar symptoms presenting various challenges for practitioners who may need to carry further tests to identify the specific condition. Both of these conditions affects the eyelid and other areas surrounding the eye. Periorbital Cellulitis is caused by infections in the area anterior to the orbital septum. Orbital cellulitis, on the other hand, causes infections to the area anterior to the Orbital septum (In Bennett et al. 2015). Differentiating the two types of infections requires an assessment of the antibiotics issued and in what amount and the symptoms the patients show.

Unlike preseptal cellulitis, orbital cellulitis is harmful to the patient as it can harm one’s sight. The failure by doctors to diagnose the patient with the correct infections among the two cellulitis can have severe consequences such as blindness. Any doubt by the practitioner regarding the condition should according to the Australian guidelines be treated as orbital cellulitis as it is the most severe of the two.

Applying the matter to the case study EM has been suffering from Orbital cellulitis. After initial treatment, EM feels pain around the eye whereas the swelling and the redness in the RHS eye continue getting worse. She was initially prescribed some paracetamol, antibiotics enough to cure against periorbital cellulitis. The symptoms EM experiences that include redness around the eye and the swelling of the eyelid matches with the ones caused by both periorbital cellulitis and orbital cellulitis (In Bennett et al. 2015). A distinction between the two closely related diseases can be made by assessing whether the vision is affected or the patient experience eye pain. The medical records point out that when the patient was admitted to the hospital, she experienced sharp pains around the eye. Despite the medication issued, the patient continued suffering from the pains for the next three days.

The Australian guidelines indicate that if a patient diagnosed with periorbital cellulitis fails to improve when treated with antibiotics, the patient should be treated for orbital cellulitis since the condition can spread into the eye sockets (In Bennett et al. 2015). Another cause for alarm is when the patient suffering from preseptal cellulitis has a high fever that develops along with the swelling and redness of the eye.

According to the case study, EM had a body temperature of 38 degree Celsius when she was admitted to the hospital. The next day on 17th February 2016 at 1330 hours the patient had a fever that had the temperature rising to 39 degree Celsius at 1900 hours. The following day on 18th February 2016, the body temperature had reached 39.5 degree Celsius whereas the pain and the redness of the eye kept getting worse. These symptoms indicate that the patient was suffering from Orbital cellulitis rather than the less serious Periorbital cellulitis. Despite being treated with paracetamol 500mg and morphine 5mg, the condition kept getting worse and only improved when she had drainage surgery.

EM also experiences difficulties to move the eyes due to the pains. Periorbital cellulitis causes infections to area inferior to the orbital septum, so no difficulties or pains are expected while making ocular movement. Orbital cellulitis, on the other hand, infects area posterior to the orbital septum including the orbital tissues, therefore, causing pains when the ocular muscles move (In Bennett et al. 2015).

The prevalence of both preseptal cellulitis and orbital cellulitis among children create the need to understand further these orbital infections focusing on the causes, symptoms, and the treatment methods available.

The preorbital infections are caused by direct external infections such as wounds or injuries, the spread of contiguous structures or even due to venous and lymphatic congestion whereas orbital cellulitis is caused by the extension of these infections. The organisms responsible for the spread of the infections include Staphylococcus aureus, Streptococcus pheumoniae or Streptococcus pyogenes but they vary depending with the etiology (In Bennett et al. 2015).

Some of the signs and symptoms that can be used to distinguish between preseptal cellulitis and orbital cellulitis include continued eye swelling and redness even after taking antibiotics, rising body temperature, decreased visual acuity and even pain while moving the ocular muscles thereby restricting eye movements (Perkin, 2008).

Diagnosis includes carrying out a CT or MRI on the patient to determine the infection. An MRI is often preferred instead of CT due to the higher success rate. Blood culture is also done to assess bacterial infections in the blood of the patient such as orbital infections. It does not only help in the identification of the type of bacteria but also acts as a guide to treatment since they vary with etiology. EM underwent a CT scan of the upper RHS skull and blood culture during the third day to determine the infection (Perkin, 2008).

The patient is issued with Cefotaxime 50mg/kg IV q 6 h, a second generation cephalosporin as treatment since sinusitis pathogens are present. Antibiotics given to EM include Paracetamol 500mg/ and codeine 30mg 4/24 prn to treat sinus pathogens such as Streptococcus pyogenes and Staphylococcus aureus.

Drainage surgery is used to treat orbital cellulitis in those cases where antibiotic therapy does not help improve the patient condition within a period of two years. It involves the removal of the orbits and sinuses from the blood of the patient. A CT scan carried on the upper RHS skull carried on EM can be used to show whether the sinus pathogens detected in the patient blood can be opacified (Perkin, 2008). A day after the surgery, swelling did not extend whereas blood culture did not reveal any growth. The body temperature also returned to normal of 37.5 degree Celsius.


Preseptal cellulitis and orbital cellulitis show similar signs and symptoms since they affect the same area and are caused by same sinuses pathogens. Practitioners should focus on the symptoms shown when a patient is suffering from orbital cellulitis and are not reflected when suffering from prespetal cellulitis. The treatment procedure to be applied is also equally crucial to the process as the diagnosis.


In Bennett, J. E., In Dolin, R., & In Blaser, M. J. (2015). Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders.

Perkin, R. M. (2008). Pediatric hospital medicine: Textbook of inpatient management. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.