Bilateral Preseptal Cellulitis and Upper Eyelid Abscess Without Predisposing Factors: A Case Report and Pathogenic Hypothesis

Bilateral preseptal cellulitis without accompanying sinusitis or skin trauma is uncommon. In this report, we present a case of bilateral preseptal cellulitis and an upper eyelid abscess in an otherwise healthy child. A nine-year-old girl presented with severe and progressive bilateral swelling of the upper lids that showed an unsatisfactory response to medical treatments (intravenous ceftazidime and vancomycin) and warranted a referral to our facility. An orbital computed tomography scan and magnetic resonance imaging revealed bilateral preseptal soft tissue swelling with a collection but without intraorbital extension or paranasal sinus fullness. The most probable cause of the condition was considered to be transient bacteremia from an unknown source. Treatment involved administering broad-spectrum antibiotics and performing surgical drainage of the lid collections. Gram-positive cocci were identified in the smear of the drained components, although bacterial growth was not observed in the culture. Intravenous antibiotics were continued for five days, resulting in a remarkable decrease in swelling. In cases of atypical presentations of infectious preseptal cellulitis with abscess formation, particularly when there is bilateral involvement without common predisposing factors, the possibility of hematogenous spread of microorganisms should be carefully considered.