Patient handout

Orbital cellulitis (vs preseptal)

PRODUCTION

1. Your condition

This handout is for orbital cellulitis (vs preseptal). Your care team identified this based on: periorbital erythema/oedema with proptosis, restricted/painful eye movements, or chemosis — postseptal (orbital) cellulitis until excluded (chandler laryngoscope 1970 pmid 5470225; le j aapos 2014 pmid 24924283).

Other reasons your team may use this plan: eyelid erythema/oedema with normal acuity, motility, and globe position — preseptal (chandler i) candidate; the septum-defining triage (brugha pediatr emerg care 2012 pmid 22344208); acute (ethmoid) rhinosinusitis developing new orbital signs — orbital complication of sinusitis (60-75% of complicated rhinosinusitis; sansa-perna acta otorrinolaringol esp 2020 pmid 32389323); painful ophthalmoplegia + decreased acuity/colour vision ± rapd — optic-nerve / orbital-apex emergency (moreddu j otolaryngol hns 2025 pmid 40652356).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
septum_triage_decision_gate_preseptal_vs_postseptal	—	—	—	Chandler Laryngoscope 1970 (PMID 5470225) — the orbital septum defines preseptal (I) vs orbital/postseptal (II-V). Postseptal = admit + IV + ophtho/ENT; preseptal-well = ambulatory/oral (Brugha Pediatr Emerg Care 2012 PMID 22344208).

Plan: Postseptal (orbital) cellulitis — IV broad-spectrum empiric + surgical-drainage decision + ROCM arm

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Decreased visual acuity, dyschromatopsia, or RAPD — optic-nerve compromise from orbital cellulitis / orbital-apex involvement (Garcia & Harris Ophthalmology 2000 PMID 10919887; Chandler 1970 PMID 5470225)(life-threatening)
Chandler III subperiosteal abscess (large/non-medial, age ≥9, or SPA volume >3.8 mL) or Chandler IV orbital abscess on contrast CT (Le J AAPOS 2014 PMID 24924283; Garcia & Harris Ophthalmology 2000 PMID 10919887)
Bilateral orbital signs, multiple cranial neuropathies (III/IV/V1/VI), fixed dilated pupil, or rapid bilateral progression — Chandler V cavernous sinus thrombosis (Chandler Laryngoscope 1970 PMID 5470225)(life-threatening)
Meningismus, altered mental status, seizure, or imaging subdural/intracranial abscess with an orbital/sinogenic source (Chandler 1970 PMID 5470225)(life-threatening)
Diabetic ketoacidosis / haematologic malignancy / neutropenia / transplant WITH black necrotic nasal-palatal eschar, rapid cranial-nerve march, or non-response to antibacterials — rhino-orbital-cerebral mucormycosis (Reid Semin Respir Crit Care Med 2020 PMID 32000287)(life-threatening)
qSOFA ≥2, hypotension on adequate fluids, or NEWS2 escalation with an orbital/sinogenic source
Young child with high fever, toxic appearance, poor feeding, or airway compromise from extensive periorbital/sinogenic disease (orbital cellulitis is pediatric-predominant; Garcia & Harris Ophthalmology 2000 PMID 10919887; Sansa-Perna 2020 PMID 32389323)
No improvement in orbital signs / inflammatory markers at 24-48 h of appropriate IV empiric therapy (Le J AAPOS 2014 PMID 24924283; Garcia & Harris Ophthalmology 2000 PMID 10919887)

5. Follow-up

Complete IV→PO course (typically 2-3 weeks total guided by source-sinusitis and complication); ENT follow-up for the source ethmoid sinusitis and FESS planning (route to ent.acute-sinusitis.core.v1 for definitive sinus management); ophthalmology follow-up for residual diplopia / optic-nerve / motility sequelae; recurrence-driver control (treat the source sinus disease); ROCM survivors → prolonged antifungal + reconstruction. Counsel return precautions: any vision change, increasing proptosis, new diplopia, headache, or altered mental status → emergency return.

6. Sources

Guideline: Chandler classification (Chandler JR et al, Laryngoscope 1970) — the universal five-stage orbital-complication-of-sinusitis frame — anchored by the Garcia-Harris non-surgical-SPA criteria (Garcia & Harris, Ophthalmology 2000; Harris, Trans Am Ophthalmol Soc 1993), CT SPA-volume thresholds (Le, J AAPOS 2014; Todman & Enzer, Ophthalmic Plast Reconstr Surg 2011), contemporary surgical-need predictors (Moreddu, J Otolaryngol Head Neck Surg 2025), MRSA-era microbiology / empiric cover (Cirks, Mil Med 2025; Vloka, Orbit 2021), orbital-complication epidemiology (Sansa-Perna, Acta Otorrinolaringol Esp 2020), preseptal ambulatory-IV evidence (Brugha, Pediatr Emerg Care 2012), and the ROCM mucormycosis emergency (Reid, Semin Respir Crit Care Med 2020). AAO/Wills-aligned. No 2024-2026 society guideline supersedes the Chandler frame.