Preseptal Cellulitis Not Recover with Medical Treatment: When Should We Consider Orbital Abscess

Orbital cellulitis is a serious infection of the fat and muscle tissue outside the eyeball. Preseptal cellulitis is a generally mild infection of the tissues in the front of the eyelid. Although both conditions can cause eye pain, eyelid swelling and erythema, they can be confused with each other, but their clinical effects are very different. Preseptal cellulitis is a mild condition that rarely leads to serious complications, whereas orbital cellulitis can cause vision loss and even death. The most common underlying cause of both conditions is the spread of infection from nearby tissues (acute sinusitis, etc.) to the orbit through the surrounding tissues. One of the most important and serious complications of orbital cellulitis is orbital abscess. When orbital abscess is detected by clinical findings and radiologic examinations, intravenous broad-spectrum antibiotic treatment and emergency surgical intervention are required immediately. In this article, we will present a case that progressed from preseptal cellulitis to orbital cellulitis and orbital abscess and required surgical treatment. In conclusion, if there is no response to treatment in orbital infections, serious complications (orbital abscess, etc.) should be considered. Differential diagnosis should be made quickly with radiologic imaging. If necessary, surgery should be performed. Management of the disease should be planned and followed in a multidisciplinary manner with joint opinions from pediatrics, ophthalmology and otolaryngology branches.