This infection involves tissues anterior to the orbital septum and is sometimes preceded by trauma or sinusitis. Staphylococcus aureus, streptococci and Haemophilus influenzae are the common pathogens. Examination reveals eyelid erythema, swelling, warmth and tenderness, but there is neither proptosis nor restriction in ocular motility. Radiographs or CT scans may show signs of sinusitis or evidence of trauma. Systemic ampicillin combined with penicillinase-resistant antibiotics is the treatment of choice. Surgical treatment is indicated in unresponsive cases or for the treatment of associated sinusitis. While this condition in adults is relatively simple to treat, in infants and young children, this can constitute an emergency. The definition of the orbital septum in these cases is poor and it is not difficult for the infection to track through the septum into the tissues of the orbit. Since the orbit contains many vital structures, infection in this region can cause serious visual loss and thus, these children must be hospitalized and treated with intravenous antibiotics - preferably a fourth-generation cephalosporin.
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