Researchers identify common causes, late complications of preseptal cellulitis

Sinusitis, upper-respiratory infection, acute dacryocystitis, and a recent history of trauma or surgery appear to be the most common causes of preseptal cellulitis, a study found.

While most patients respond favorably to systemic antibiotics, patients may experience late complications that require surgical intervention, the authors said.

Imtiaz A. Chaudhry, MD, PhD, FACS, and colleagues retrospectively reviewed medical records obtained for 104 patients who had presented with preseptal cellulitis positioned anteriorly to the orbital septum between January 1991 and December 2005. The study results were published in the October issue of British Journal of Ophthalmology.

Follow-up averaged 3.2 years.

The investigators found that preseptal cellulitis had been caused by acute dacryocystitis in 32.6% of patients, upper-respiratory infection or sinusitis in 28.8% of patients, and trauma or recent surgery in 27.8% of patients.

Half of the patients required surgery; of these patients, 74% underwent dacryocystorhinostomy with probing and stenting, and 28.8% underwent abscess or chalazion drainage.

Among the 40 patients (38.5%) who had surgical intervention and cultures were performed, 36 (90%) were positive; Staphylococcus and Streptococcus species were the most frequent micro-organisms, followed by Haemophilus influenzae and Klebsiella pneumoniae.

The investigators identified positive blood cultures in two of the 34 patients in whom blood was drawn.

Late complications included subacute lid abscesses, eyelid necrosis and cicatricial ectropion.