Orbital Cellulitis in a Pediatric Population – The Experience of Large Tertiary Center

Introduction

Orbital cellulitis is considered a serious and severe bacterial infection observed in the pediatric population, with life-threatening complications (ocular or intracranial). Practice guidelines for the management of orbital cellulitis in children differ worldwide, hence, optimal management, including surgical interventions, are not well established. We describe our tertiary center’s experience in treating a large cohort of children with orbital cellulitis

Method and Subjects

A retrospective analysis of the medical records of children with orbital cellulitis was conducted between 2005- 2018. Demographics, clinical features, laboratory and radiology characteristics, management microbiological data, and outcomes, were collected from all medical files.

Results

Ninety-four cases were treated in our center during the study period; Fever (51%) and nasal congestion (20.2%) were the most prevalent presenting features. Proptosis was observed in 38.2%; painful restriction of ocular motility in 32.9%. Only 17 (18%) children presented with both of these classical signs. Most (67, 68%) underwent computed tomography (CT) during hospitalization, with findings of a subperiosteal abscess (56.7%) and sinusitis (34.3%). Favorable outcome was recorded in all cases, however, only a minority (12, 12.4%) required functional endoscopic sinus surgery.

Conclusions

Orbital cellulitis continues to be a serious paediatric medical condition .We found wide variations in clinical presentations as well as in the management of the infection. Our conclusions emphasize that children with orbital cellulitis can be managed with conservative treatment. CT imaging as well as surgical interventions should be reserved for those showing no improvement or a deterioration while under proper antibiotic treatment.