Orbital Cellulitis

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Definitions of cellulitis involving the eyes

Orbital cellulitis diagram

Pre-septal, peri-orbital cellulitis

  • Infection confined to the eyelid and superficial tissues anterior to the orbital septum
  • Proptosis and impaired ocular mobility should be absent. 
  • Manage as per Cellulitis.

Post-septal, orbital cellulitis

  • Deeper infection within the tissues of the orbit. 
  • Proptosis may be present.
  • Impairment or painful eye movements.
  • Vision including colour vision may also be affected.
  • This is an emergency. Seek immediate specialist advice from ENT, Ophthalmology and Microbiology. 
  • Consider CT imaging, and drainage.
  • Follow antimicrobial recommendations below.

Antibiotic recommendation

Total recommended duration: 7 days (Total duration = IV + oral)

Recommended Antibiotic

Ceftriaxone 2g every 12 hours IV

AND

Metronidazole 400mg every 8 hours orally (or 500mg every 8 hours IV if oral route unavailable)
Severe Penicillin allergy

Vancomycin IV (use NHS Lothian Calculator located AMT intranet page) choose trough 15-20 mg/L

AND

Gentamicin IV (use NHS Lothian Calculator located AMT intranet page)

AND

Metronidazole 400mg every 8 hours orally (or 500mg every 8 hours IV if oral route unavailable)
Previous MRSA

Vancomycin IV (use NHS Lothian Calculator located AMT intranet page) choose trough 15-20 mg/L

AND

Ceftriaxone 2g every 12 hours IV

AND

Metronidazole 400mg every 8 hours orally (or 500mg every 8 hours IV if oral route unavailable)

 

IV to oral switch

Review sensitivities

Recommended Antibiotic

 Co-amoxiclav 625 mg every 8 hours
Penicillin allergy OR previous MRSA (check sensitivities)

Doxycycline 100mg every 12 hours orally 

AND

Metronidazole 400mg every 8 hours orally

OR

Co-trimoxazole 960mg every 12 hours orally

AND 

Metronidazole 400mg every 8 hours orally

 

Notes

Likely organisms: S. aureus, Group A Streptococci, respiratory bacterial pathogens - Haemophilus, Pneumococcus etc.