Management of Periorbital Cellulitis in Pediatric Emergency Department

Periorbital cellulitis is common condition in pediatric emergencies. This is a diagnostic and therapeutic emergency due to the risk of ocular and neurological complications.

The objective of our work is to assess and possibly improve the management of patients with orbital cellulitis.

We conducted a retrospective study from January 1, 2010 to February 28, 2019 in the pediatric emergency department at the mother-child hospital of the Mohammed VI University Hospital where we recruited 129 patients whose age varied between one month and 15 years, the mean age was 4.3 years with a sex ratio of 0.84. In 78% of cases the orbital cellulitis was pre-septal. Palpebral edema was constant; fever was present in 101 patients, exophthalmos in 18 patients, chemosis in 11 patients, and ptosis in a single patient. Orbital and cerebral CT were performed for all patients in our series. The bacteriological study was only performed for 12 patients and only returned positive in 7 patients. The medical treatment was based on Ceftriaxone, metronidazole +/- aminoglycoside or protected amoxicillin, the surgical treatment was only indicated for 8 patients including 3 cases of orbital abscess. The outcome was favorable for all of our patients.

The management of periorbital cellulitis is a multidisciplinary emergency involving otolaryngologists, ophthalmologists, pediatricians, in particular neuro-pediatricians and radiologists. Good collaboration and adequate treatment would significantly reduce the mortality and morbidity associated with this pathology.