The Management of Periorbital Cellulitis

Periorbital cellulitis is a relatively common condition in Pediatric Emergencies, where the high risk of developing serious ocular and neurological complications requires early diagnosis and appropriate treatment. The work described in this study was directed at learning more about how periorbital cellulitis is managed, and steps that can be taken to improve the management of these conditions. For this goal, we performed a retrospective study including 129 patients who presented to the Pediatric Emergency in The Mother-Child Hospital (CUH Mohamed VI) Marrakech during a period of 9 years and 2 months. The age ranged between 1months and 15 years with an average age of 4.3 years. The study noted a female predominance with a sex ratio of 0.84. Preseptal cellulitis was present in 101 cases (78%), while 28 cases had retrostseptal cellulitis (22%). In the most cases, infection occurred in relation with sinusitis. Fever was present in 62 patients (48%). The eyelid oedema was constant. proptosis was noted in 18 patients, chémosis found in 29 cases and ptosis in one patient. The bacteriological study was done in 12 cases, it returned positive in 8 cases. Orbito-cerebral CT was performed in all cases in our series, showed a pre-septal cellulite in 101 cases, orbital cellulitis in 11 cases, a subperiosteal abscess in 15 cases, and orbital abscess in 2 cases. Medical treatment was based on Ceftriaxone, Metronidazole +/- aminoglycoside. Or protected Amoxicillin. Surgical treatment was indicated in 8 patients: 3 cases of orbital abscess, 2 case of periosteal abscess and 3 cases of abscess collection of the soft tissues. The outcome was favorable in all our patients. Child`s perobital are seen as a disease requiring medical multidisciplinary approach. Thus early diagnosis, appropriate antibiotic therapy and sometimes surgical treatment combined, can significantly reduce mortality and morbidity associated with this pathology.