Paediatric Acute care Guidelines PMH Emergency Department


Orbital Cellulitis

Several conditions can present in a similar way, but all of these are ophthalmological emergencies and are approached in the same way:

  • Orbital cellulitis
  • Orbital abscess
  • Subperiosteal abscess
  • Cavernous sinus thrombosis

Key signs:

  • Decreased visual acuity
  • Proptosis
  • Ophthalmoplegia
  • Red eye
  • Papilloedema, meningism or cranial nerve involvement. Consider cavernous sinus thrombosis
Likely Organisms: 
  • Streptococcus pyogenes
  • Streptococcus pneumoniae
  • Staphylococcus aureus
  • Haemophilus influenzae in unimmunised children

Periorbital Cellulitis

  • This involves pre-septal soft tissue infection. Likely infections are the same as for cellulitis, but the presence of a contiguous skin lesion (insect bite, scratch etc) makes S. pyogenes and S. aureus more likely. 



  • The assessment of the severity of the presentation will determine the management 
Consider allergic reaction Mild  Moderate  Severe/Ophthalmological Emergency 
  • Localised swelling
  • No tenderness
  • No redness
  • Afebrile
  • Mild redness and swelling
  • Systemically well 
  • Moderate redness and swelling
  • +/- systemically unwell 
  • Decreased visual acuity
  • Proptosis
  • Ophthalmoplegia
  • Red eye


  • Please speak to the Clinical Microbiologist or Infectious Diseases for advice regarding management of children < 3 months of age with mild to severe periorbital cellutilis

Management of children ≥ 3 months of age: 

Allergic Reaction  Mild  Moderate  Severe/Ophthalmological Emergency 
  • Trial antihistamine 
  • Oral Amoxycillin/clavulanic acid; see Antibiotics 
  • ED/GP review within 24 hours 
  • Admit 
  • Commence IV Flucloxacillin and Ceftriaxone; see Antibiotics
  • Urgent ophthalmology consult
  • CT
  • Urgent ENT referral if abscess or cavernous sinus throbosis
  • Bloods culture and FBC
  • Commence IV Vancomycin  and Ceftriaxone; see Antibiotics



We want your feedback!

Help us provide guidelines that are useful to you, the clinician.

Give feedback here