Periorbital cellulitis is an infection of the eyelid or the skin around the eye, which can cause a swollen eyelid, the area around the eye to be red, tender and/or warm to touch. Some children may have a fever and not be able to open their eye fully.

It can be caused by a minor injury to the eye or following an infection, such as a cough or cold, or the infection can spread to the eye following sinusitis.

Periorbital cellulitis usually responds well to oral antibiotics (taken by mouth), but there are times when the infection is more severe or the infection has not responded to oral antibiotics and your child will require antibiotics through their vein (intravenous antibiotics).

The health professional that has seen your child will have assessed the severity of your child’s condition and decided whether they can be cared for safely at home or in hospital. Some children, who are treated with intravenous antibiotics, may be able to go home but return to hospital once a day for review and treatment. If your child is treated with intravenous antibiotics and their symptoms improve, there is the possibility of changing to oral antibiotics. Antibiotics are usually given for 7-10 days.

Occasionally, periorbital cellulitis can progress, and the infection can involve deeper tissues 
around the eye or the eyeball itself (orbital cellulitis). This will require immediate care and 
intravenous antibiotics.

How is your child?

Call 999 or attend your nearest emergency department if your child develops any of the symptoms listed below:

  • Going blue around the lips or too breathless to talk, eat or drink.
  • Appears unwell – unusually irritable, agitated, or lethargic.
  • Pale or mottled skin.
  • Passing less urine then normal.
  • Cold hands and feet.
  • Develops a rash that does not disappear with the ‘glass test’ (when a glass is pressed firmly to the rash affected area).

Contact or return to the hospital if your child develops any of the following symptoms:

  • Swelling becomes worse, despite the antibiotics.
  • Pain when moving the eye.
  • If the eye appears to stick out or bulge.
  • Fever worsening or not improving.
  • Fast heartbeat.
  • Difficulty in breathing.
  • Changes in their behaviour.

If none of the above features apply to your child, then your child can continue to be looked 
after safely at home.

Caring for your child at home

  • You can give your child regular pain relief (paracetamol and/or ibuprofen) until the discomfort as improved.
  • Ensure your child is fully vaccinated as two of the bacteria known to cause this infection are covered by your child’s routine vaccination schedule.
  • Keep the eye clean and dry.
  • Encourage your child to drink plenty of fluids to keep them well hydrated, especially if they have a fever.
  • Good hand washing is important. You and your child should wash your hands with soap (liquid if possible) in warm running water and then dry them carefully, especially before or after touching the eye.

If your child appears well but you are still concerned or need further advice, please contact your GP or NHS 111. This leaflet has been written by paediatric healthcare professionals with reference to the National Institute for Health and Care Excellence (NICE) guidelines for cellulitis.