Factors Associated with Increased Risk for Pediatric Orbital Cellulitis – Who Should We Scan?

Background: the differentiation between pre septal and post septal orbital cellulitis is cardinal, while specific clinical signs and symptoms were found indicative for increased risk of orbital cellulitis, computed tomography remains the gold standard for establishing the diagnosis.

In this study the value of ancillary laboratory tests in the diagnosis of OC was assessed.

Method: Retrospective review of children 0-16 years admitted to the PED for POC\OC from 2009-2019.

Results: Two hundred forty seven children were included in the study. OC was documented in 51 patients (20.6%).

Patients with OC had mean CRP levels of 11.7 (mg\dL) vs 4.9(mg\dL) (p 0.0001), ESR was elevated in the OC 53.6 (cm\hr) vs 36.4 (cm\hr) (p 0.02).

Mean leukocyte count in the OC group was 15.2(10⁹\L) vs 13.4(10⁹\L) (p 0.05), ANC was significantly higher in the OC 11.3(10⁹\L) vs 7.2(10⁹\L) (p 0.0001), NLR ( neutrophils to lymphocytes ratio ) of 0.318 correlates with orbital cellulitis with sensitivity of 75.5% and specificity of 77.4%.

Fever (80.4%), URTI (43%), swelling of both eyelid (96%) and proptosis (33.3%) were more common in comparison to POC (p 0.0001, 0.03, 0.0001, 0.0001,0.0001 respectively).

Based on the aforementioned study a risk calculator for OC was formulated with 5 major variables.

Conclusion: This study highlights the importance of ancillary laboratory tests especially CRP in the assessment of infections of the eye, and provides a useful tool incorporating different variables to assess the risk for OC.