What is the typical presentation of periorbital cellulitis?

• A. Unilateral erythema, swelling, warmth, and tenderness of the eyelid without vision changes.
• B. Itchy eyes with tearing.
• C. Bilaterial painless proptosis.
• D. Red eye with severe vision loss.

Answer: (A)

Periorbital cellulitis is an infection of the eyelid and the skin around the eye that lies in front of the orbital septum. The classic presentation is acute, unilateral eyelid swelling with redness, warmth, and tenderness, and vision is preserved because the infection does not involve the globe or optic nerve. Patients usually look fairly well aside from the local eyelid findings, and eye movements are not restricted.

This helps distinguish it from other eye conditions: itching with tearing suggests conjunctivitis rather than cellulitis of the eyelid; bilateral painless proptosis would point toward a non-infectious or orbital process rather than acute periorbital cellulitis; red eye with severe vision loss implies intraocular or orbital pathology such as keratitis, endophthalmitis, optic neuritis, or glaucoma, which are not typical of periorbital cellulitis.