preseptal

Preseptal describes structures and conditions located anterior to the orbital septum, a fibrous membrane that extends from the orbital rim to the eyelids. The preseptal region includes the eyelids and surrounding periorbital soft tissues. The term is most commonly encountered in discussions of preseptal cellulitis, an infection confined to these anterior tissues.

Preseptal cellulitis is the typical condition associated with this term. It involves the eyelid and periorbital tissues without involvement of the orbital cavity. Most cases arise from spread of adjacent infections such as sinusitis, local trauma, insect bites, or conjunctival infections. It is more common in children, but can occur in adults. Patients usually have eyelid swelling, erythema, warmth, and tenderness, sometimes with fever. Vision is typically preserved and there is no restriction of eye movements; orbital signs such as pain with ocular motion, proptosis, or decreased vision suggest orbital cellulitis, which requires different management.

Diagnosis is mainly clinical. Imaging with CT or MRI is reserved for cases with uncertain diagnosis, concern for orbital involvement, poor response to initial therapy, or suspected complications such as abscess. Laboratory testing may support an inflammatory response but is not always necessary.

Treatment ranges from oral to intravenous antibiotics, depending on severity. Mild cases can be treated with oral agents that cover common skin flora (for example, amoxicillin-clavulanate or a cephalosporin). In areas with MRSA risk or in moderate to severe cases, antibiotics with broader coverage or intravenous therapy are used, and hospital admission may be required. Treatment also includes addressing any concurrent sinus disease and close follow-up to ensure resolution.

Prognosis is generally good with prompt treatment. Potential complications include progression to orbital cellulitis or abscess formation within the preseptal space if treatment is delayed or inadequate.