This guideline last updated 09/05/2022 10:09:05

Differential diagnosis

• Preseptal cellulitis
• Hordeolum (external or internal)
• Acute blepharitis
• Insect bite or sting
• Viral conjunctivitis with eyelid swelling
• Allergic conjunctivitis with eyelid swelling
• Angioneurotic oedema (if bilateral- could indicate severe systemic allergic reaction)
• Orbital cellulitis
• Cavernous sinus thrombosis
• Mucormycosis (fungal infection)
• Sarcoidosis
• Dysthyroid exophthalmos
• Neoplasia with inflammation
• Acute allergic conjunctivitis

Possible management by Optometrist

Treatment

• Orbital cellulitis-none
• Pre-septal cellulitis- co manage with GP  adult patients who are systemically well 
  • POM Co-amoxiclav 500/125 mg every 8 hours for 7 days then review
  • If allergic to penicillin, then POM Erythromycin 500 mg 4 times a day for 5–7 days then review

Advice

• Orbital cellulitis and paediatric pre-septal cellulitis- Emergency (same day) referral
• Pre-septal cellulitis in adults- 

Management Category

• Emergency (same day) referral to ophthalmologist or A&E Department

Possible management by Ophthalmologist

• Systemic antibiotics (parenteral and/or oral)
• Drainage of orbital abscess