Periorbital Cellulitis vs Pink Eye: Spot the Difference

Definition of Periorbital Cellulitis and Pink Eye

What Is Periorbital Cellulitis?

Periorbital cellulitis is an infection that affects the eyelid and the skin around the eye, but not the eyeball itself. It causes swelling, redness, and tenderness, and is most common in children under 5, though it can occur at any age.

The infection often starts from a nearby sinus problem, injury, or skin break near the eye. If not treated promptly, it can spread quickly and become more serious.

• Preseptal cellulitis: Affects the front part of the eyelid and skin.
• Orbital cellulitis: A more serious condition that affects deeper tissues behind the eye. This requires emergency care.

What Is Pink Eye?

Pink eye, or conjunctivitis, is the inflammation of the thin layer that covers the white of the eye and the inside of the eyelids. It causes redness, irritation, and discharge but is usually mild. Pink eye is commonly 

Pink eye spreads easily, especially in schools or crowded places. Most cases improve on their own, but some may need medical attention.

• Viral: Most common, spreads quickly, often starts in one eye and spreads to the other.
• Bacterial: Causes thick yellow or green discharge.
• Allergic: Triggered by allergens like pollen or pet dander and usually affects both eyes.

Key Differences Between Periorbital Cellulitis and Pink Eye

Symptoms of Periorbital Cellulitis and Pink Eye

What Symptoms Does Periorbital Cellulitis Have?

These symptoms often appear on one side and may develop quickly:

• Swelling and redness around one eye
• Pain or tenderness in the eyelid
• Fever or chills
• Difficulty opening the eye due to swelling
• Eye may look bruised or puffy

If the swelling spreads, gets worse in a few hours, or comes with a fever, it’s important to get medical help right away.

What Symptoms Does Pink Eye Have?

Pink eye affects the surface of the eye and is often less intense than cellulitis. It usually begins with irritation and spreads more slowly:

• Red or pink eye (usually both)
• Itching or burning sensation
• Watery or sticky discharge
• Eyelids stuck together in the morning
• Mild swelling of the eyelid

Pink eye often feels uncomfortable but doesn’t usually cause pain, fever, or severe swelling.

How to Tell the Symptoms Apart

While both conditions can cause redness and swelling, there are key differences that help tell them apart:

• Pain and location: Periorbital cellulitis causes pain and swelling around the eye, not in the eye itself. Pink eye causes irritation on the eye’s surface (the conjunctiva) but is usually not painful.
• Discharge and discomfort: Pink eye often includes discharge and itchy, gritty sensations. Cellulitis rarely causes discharge but may make the eye feel tight and sore.
• Fever and severity: Cellulitis often comes with fever and symptoms that worsen quickly, making it a medical concern. Pink eye develops more slowly and usually clears up on its own or with basic treatment.

What Causes Periorbital Cellulitis and Pink Eye?

Causes of Periorbital Cellulitis

Periorbital cellulitis happens when bacteria infect the soft tissues around the eye. This often occurs after:

• Sinus infections, especially in children
• Cuts, scrapes, or injuries near the eye
• Insect bites on or near the eyelid
• Spread from nearby skin infections, such as a stye or infected pimple

The infection usually affects just one eye and can become serious if not treated quickly.

Causes of Pink Eye

Pink eye affects the thin layer covering the white of the eye and inside the eyelids. It has several different causes, including:

• Viruses, often linked to colds or respiratory infections
• Bacterial infections, which are more common in children
• Allergies, such as pollen, pet dander, or dust mites
• Irritants, like smoke, chlorine in pools, or makeup residue

Most forms of pink eye are contagious, especially the viral and bacterial types.

Main Differences in Causes

Periorbital cellulitis starts from bacteria entering broken skin or sinuses. Pink eye is often triggered by viruses or allergens and spreads through contact.

How Doctors Identify Periorbital Cellulitis and Pink Eye

How Periorbital Cellulitis Is Diagnosed

To diagnose periorbital cellulitis, doctors start with a physical exam, paying close attention to the area around the eye. They’ll check for signs like swelling, redness, and warmth, and will carefully assess your eye movements and vision to make sure the infection hasn’t spread deeper.

If the condition seems severe or isn’t improving, additional tests may be needed to confirm the diagnosis or rule out orbital cellulitis. These may include:

• A complete blood count (CBC) to check for signs of infection
• A blood culture to identify any bacteria present
• Imaging such as a CT or MRI scan to examine the tissues behind the eye

These tests help determine how far the infection has spread and guide the treatment plan.

How Pink Eye Is Diagnosed

Doctors check the eyes for redness, discharge, and irritation. They ask about symptoms like itching, recent illness, or exposure to others with pink eye.

Lab tests are rare unless the infection is severe or doesn’t improve.

Key Differences in Diagnosis

Periorbital cellulitis may need imaging and other tests to check for spread. Pink eye is usually diagnosed by appearance and history alone.

How Are Periorbital Cellulitis and Pink Eye Treated?

Treatment for Periorbital Cellulitis

This condition needs prompt medical care. Treatment focuses on stopping the infection and reducing swelling.

Delays can lead to serious complications like orbital cellulitis or vision loss.

Treatment for Pink Eye

• Viral pink eye usually clears on its own in a few days.
• Bacterial types may improve with care and hygiene.
• Allergic pink eye gets better when the allergen is removed.

Home care includes using clean towels, avoiding rubbing the eyes, and frequent handwashing.

How Treatments Differ

Periorbital cellulitis needs urgent treatment and may require close follow-up. Pink eye is usually mild and often improves with simple care at home.

How to Prevent Periorbital Cellulitis and Pink Eye

Prevention Tips for Periorbital Cellulitis

• Treat sinus infections early
• Keep cuts or insect bites near the eyes clean
• Avoid rubbing or scratching the eye area
• Clean minor facial wounds with soap and water

Prevention Tips for Pink Eye

• Wash hands frequently
• Don’t share eye drops, makeup, or towels
• Avoid touching or rubbing your eyes
• Clean pillowcases and sheets often

What Prevention Tips Work for Both?

Many daily habits reduce the risk of both conditions:

• Keep your hands and face clean
• Avoid close contact with people who have eye infections
• Practice good hygiene after being in public spaces

Complications: Why Early Action Matters

Complications of Periorbital Cellulitis

• Spread of infection behind the eye (orbital cellulitis)
• Vision problems
• Infection reaching the brain (rare but serious)

Complications of Pink Eye

• Corneal inflammation in severe or untreated cases
• Long-lasting irritation
• Spread to others if not managed

Which Is More Dangerous?

Periorbital cellulitis carries more serious risks if not treated in time. Pink eye is rarely dangerous but very contagious.

Can Pink Eye Turn Into Periorbital Cellulitis?

Yes. This can happen if a bacterial form of pink eye spreads to the skin around the eye.

The risk increases when the eye is rubbed often or if hygiene is poor. Bacteria can enter through tiny cracks in the skin, especially if there’s irritation or discharge present.

To lower the risk, avoid touching your eyes, wash your hands frequently, and keep the eye area clean.

If swelling spreads beyond the eye or symptoms worsen quickly, seek medical help right away.

When to Seek Medical Help

It’s time to see a doctor if:

• One eye becomes swollen, red, and painful
• There's a fever or chills
• Eye symptoms worsen quickly
• Vision becomes blurry or double
• You can’t move the eye without pain

Even if it seems like pink eye, unusual symptoms should never be ignored, as it could be one of several conditions that are often misdiagnosed as pink eye.