Approach

Differentiation between peri-orbital and orbital cellulitis is imperative as the latter has greater morbidity. Diagnosis of peri-orbital cellulitis is based on history and complete ophthalmological examination. Ophthalmoplegia, proptosis, and visual disturbances are key differentiating factors for orbital cellulitis, and if suspected, a CT or MRI should be ordered to confirm the diagnosis. Cultures are usually negative for both, but can be obtained prior to treatment if they are readily accessible. Culture of the nasopharynx and conjunctiva may also be done. However, in most cases, therapy is started empirically.

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