This handout is for preseptal (periorbital) cellulitis. Your care team identified this based on: eyelid / periorbital erythema and oedema with normal acuity, normal colour vision, full painless eye movements, no proptosis — preseptal (chandler i) candidate (chandler laryngoscope 1970 pmid 5470225; baiu & melendez jama 2020 pmid 31935029).
Other reasons your team may use this plan: periorbital swelling with proptosis, painful/restricted eye movement, decreased acuity/colour, rapd, or chemosis — postseptal until excluded; route to ophtho.orbital-cellulitis.core.v1 (murphy j paediatr child health 2020 pmid 32987452); eyelid/periorbital skin or adnexal breach as portal — insect bite, trauma/laceration, hordeolum/stye, impetigo, conjunctivitis (friedel am j ther 2019 pmid 28452841; rimon j pediatr ophthalmol strabismus 2008 pmid 18825903); adjacent acute (ethmoid) sinusitis or dacryocystitis as the source — higher cross-to-orbital risk; lower threshold to image/admit (jackson & baker head neck surg 1987 pmid 3312114; shih br j ophthalmol 2021 pmid 34607790).
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); Baiu & Melendez JAMA 2020 (PMID 31935029) — the orbital septum defines preseptal (I) vs orbital/postseptal (II-V). Preseptal-well = oral + close review; ANY orbital sign → route to ophtho.orbital-cellulitis.core.v1 (Murphy J Paediatr Child Health 2020 PMID 32987452 — proptosis the strongest surgical predictor). |
Plan: Preseptal (Chandler I) cellulitis — oral-first + IV escalation + source control + route-to-orbital trigger
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Complete the oral course (typically 7-10 d guided by source and response); treat and follow the SOURCE — definitive lacrimal management for recurrent dacryocystitis (anatomic cause; route to ENT/oculoplastics), ENT source-sinus management routed to ent.acute-sinusitis.core.v1, hordeolum/blepharitis lid hygiene, conjunctivitis treatment. Counsel return precautions: any vision change, double vision, eye-movement pain, the eye pushing forward (proptosis), increasing swelling, or fever → emergency return for orbital reassessment (the preseptal→orbital progression risk — Kornelsen Cochrane 2021 PMID 33908631). Recurrent preseptal disease → reconsider an anatomic lacrimal cause.
Guideline: Chandler classification (Chandler JR et al, Laryngoscope 1970) — stage I IS preseptal in the universal five-stage orbital-complication frame — anchored by the contemporary periorbital-vs-orbital review (Baiu & Melendez, JAMA 2020), the preseptal/orbital proportion + sinusitis-predisposition series (Jackson & Baker, Head Neck Surg 1987), pediatric predictors of post-septal disease/surgery (Murphy et al, J Paediatr Child Health 2020), the insect-bite oral-outpatient evidence (Friedel et al, Am J Ther 2019), the MRSA-era adult-source microbiology (Shih et al, Br J Ophthalmol 2021), the Hib/PCV epidemiology-shift series (Ambati, Ophthalmology 2000; Rimon, J Pediatr Ophthalmol Strabismus 2008), the ambulatory-IV preseptal evidence (Brugha & Abrahamson, Pediatr Emerg Care 2012), the conservative-IV-then-escalate series (Šuchaň, Cesk Slov Oftalmol 2014), and the corticosteroid-evidence Cochrane review (Kornelsen, Cochrane 2021). AAO/Wills-aligned. No 2024-2026 society guideline supersedes the Chandler septum frame.