Advanced Cases: Eye Swelling


  • 53 y/o male p/w complaints of L eyelid swelling and redness
  • Started 4 days PTA as small pimple which he popped, and slowly progressed to “softball” sized area of swelling with pus drainage
  • Subjective fevers


Physical Exam

  • BP 153/90, pulse 80, temp 98.6, RR 17
  • Extensive soft tissue erythema and edema of the L upper eyelid, 5x5 area of fluctuance with active pus draining from small laceration

  • Visual acuity: 20/40 R, 20/70 L

  • No corneal abrasions or ulceration on fluorescein staining 

  • IOP 21 bilaterally 



  • Preseptal / periorbital cellulitis
  • Orbital cellulitis
  • Abscess



  • Labs: CBC, BMP, lactate, wound culture
  • Started empirically on broad spectrum abx: 2g vancomycin + 3g unasyn
  • CT orbits w/ contrast: significant soft tissue swelling of the L periorbital region consistent with inflammatory/infectious process, and involvement of the medial orbital wall along the lamina papyracea 


Clinical Course

  • Admission for continued IV antibiotics
  • Repeat CT orbits
  • Consults: OMFS, ophthalmology, ENT, ID 


Take home points

  • MUST differentiate orbital vs preseptal cellulitis given the increased morbidity and mortality a/w orbital (see table)
  • Confirm clinical suspicion with CT imaging
  • Orbital cellulitis complications: subperiosteal abscess, orbital abscess, vision loss, cavernous sinus thrombophlebitis, and/or brain abscess 




Involves muscle and fat within the orbit

Anterior to the orbital septum

Eyelid swelling, erythema PLUS pain w/ eye movements, proptosis, ophthalmoplegia w/ diplopia pain, afferent pupillary defect

Eyelid swelling, erythema 

Complications MORE common

Complications LESS common

IV antibiotics

Oral antibiotics