Orbital Cellulitis in the Pediatric Emergency Department:
Who Needs CT or Surgery?

Background and Objectives
Orbital cellulitis may lead to severe complications, necessitating rapid diagnosis and intervention. Our objective was to determine differences between patients managed surgically and those managed conservatively in order to understand which factors may differentiate between cases necessitating rapid imaging and surgical intervention, from those that can be managed conservatively.

Methods
This was a retrospective cohort study of all patients admitted to two major pediatric emergency departments in Israel between 2010 and 2020 with a diagnosis of orbital cellulitis or abscess and at least one high-risk symptom for orbital involvement. Variables analyzed included age, length of symptoms, laboratory tests, CT timing and results, whether the case was managed surgically or conservatively, and whether the patient returned to the same hospital with significant complications.

Results
Ninety five patients were included; 70 underwent a CT scan in the first 24 hours, and of those 21 were managed surgically. When comparing groups based on management, we found no significant differences based on presenting symptoms, duration of complaints, severity of CT findings, or number of symptoms. However, having three or more high-risk presenting symptoms was associated with a greater likelihood of surgical intervention.

Conclusions
Decision-making guided by clinical impression indicates the necessity of further research in collaboration with other specialties to establish appropriate guidelines for imaging and surgical intervention in patients with suspected orbital cellulitis.