Which symptom should prompt immediate return or contact after starting treatment for preseptal cellulitis?

• A. Pain or fever
• B. Itching only
• C. No symptoms
• D. Visual field loss

Answer: (A)

The key idea is recognizing signs that the infection may be spreading beyond the eyelid and/or not responding to treatment. Fever and new or worsening pain are red flags that the process could be progressing toward the orbit or becoming systemic, which means the patient needs prompt re-evaluation, possible imaging, and a change in management (often to IV antibiotics or inpatient care). These symptoms reliably indicate that things aren’t improving with the current outpatient treatment.

Itching alone, or having no symptoms, doesn’t signal trouble in the same way, and while vision changes would be serious and require urgent care, fever or increasing pain is the most consistent trigger for immediate return during initial treatment.