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Periorbital cellulitis — RACP Paediatrics MCQ

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ModerateIDPeriorbital cellulitisRACP Paediatrics

An 8-year-old presents with rapidly spreading facial cellulitis originating from a periorbital insect bite. There is marked periorbital swelling but no proptosis, pain with eye movement, or visual impairment. Temperature is 39°C. What is the most appropriate management?

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Correct answer: C — IV flucloxacillin

Moderate-severe periorbital (preseptal) cellulitis, particularly with systemic features, requires IV flucloxacillin (or IV ceftriaxone if Haemophilus or streptococcal cause suspected). Orbital cellulitis (proptosis, ophthalmoplegia, visual impairment) requires CT orbit and broader antibiotic cover. Careful examination to distinguish preseptal from orbital cellulitis is critical.

Reference: RCH Melbourne – 2023 – Periorbital and Orbital Cellulitis CPG; Australian Therapeutic Guidelines – 2024