Factors Associated with Increased Risk for Pediatric Orbital Cellulitis – Who should we scan?

Background: Periorbital cellulitis (POC) is a common infection in the pediatric population with minor complications. Orbital cellulitis (OC) carries Potential devastating complications of intracranial infection and vision impairment. Precise evaluation of a child with POC\OC is complicated due difficulties in physical examination and risks of imaging by CT.

Method: A retrospective review of children aged 0-16 years admitted to the ED for POC or OC from 2009 to 2019.

Results: Over the ten years study period, 247 children < 16 years were admitted to the ED with the diagnosis of OC\POC. Mean age 5.2 ± 4.5 years of age.

OC documented in 50 patients. The mean age was 7.8 ± 4.3 years. Fever (79.6%), URTI (42.9%), swelling of both eyelid (98%), proptosis (30.6%), and tenderness on percussion (24.5%) were all more common in comparison to POC with P values of 0.0001, 0.03, 0.0001, 0.0001,0.0001 respectively. All children with diagnosis of OC underwent CT scan. Abscess was documented in 63.3% of the OC patients.

POC accounted for 247 patients. Mean age was 4.6 ± 4.3 years. In 19.8% of the cases local trauma or bite mark in the infected eye were recorded.

Mean leukocyte count (10⁹\L) in OC group 15.2 vs 13.4 (P= 0.05), ANC was significantly higher in the OC 11.3 vs 7.2 (P=0.0001) whereas the lymphocyte count was higher in the POC 4.5 vs 2.4 (P= 0.0001). Laboratory inflammation signs in OC had mean CRP levels (MG%) of 11.7 vs 4.9 (P =0.0001) and ESR of 53.6 vs 36.4 (P= 0.02).

Conclusion: Differentiation between OC an POC is cardinal. while previously findings on clinical examination such as ophthalmoplegia and proptosis were found indicative of OC rather than POC, our study highlights the importance of inflammatory markers including ANC, CRP and ESR in the assessment of infections of the eye.