Preseptal cellulitis and orbital cellulitis can both present with increasing swelling, tenderness and redness around the eye, but their management differs. Preseptal cellulitis is more common and much less aggressive than orbital cellulitis. In contrast, orbital cellulitis is a medical emergency requiring urgent management. In this article, we provide a systematic approach to distinguish between preseptal cellulitis and orbital cellulitis at presentation, as the distinction between the two entities and the prompt recognition of orbital cellulitis can be potentially life-saving.