Evaluation of patients with orbital infections

Abstract

Aim: Orbital tissue infections are common infections of childhood that can lead to severe complications. Herein, we aimed to evaluate the etiologic factors, diagnosis, follow-up, and treatment procedures in pediatric patients with orbital infections. Material and Methods:This study was performed retrospectively between January 2014 and December 2015 in Cerrahpasa Medical Faculty Pediatric Infectious Disease Unit. Patients were studied for age, ophthalmologic examination features, laboratory and radiology results, treatment modalities, and the response to these treatments.Results: Thirty-six patients (21 males, 15 females) with an average age of 71.43±42.24 months (5-168 months) participated in the study in the two-year period. Thirty-two patients (88.9%) had preseptal cellulitis, and four (11.9%) had orbital cellulitis. All patients had eyelid hyperemia, edema, and ocular pain, with chemosis in seven and proptosis in four cases. Twenty-five patients were admitted with fever. All cases were unilateral and 44.4% occurred secondary to paranasal sinusitis. All cases were treated with intravenous cefazolin-amikacin. The mean of duration of hospitalization was 12.02±8.75 days (range, 3-28 days) and the duration of parental antibiotics was 12.83±8.18 days (range, 7-21 days). All patients recovered without any vision loss, only one patient experienced subdural empyema complicating preseptal cellulitis. Conclusions:Most orbital tissue infections occur secondary to paranasal sinusitis in childhood. Orbital tissue infections can be complicated by brain abscess, cavernous sinus thrombophlebitis, and vision loss. Early diagnosis and proper antibiotic treatment are essential to prevent these life-threatening complications.

Pediatric Preseptal and Orbital Cellulitis: Analysis of Clinical, Laboratory and Imaging Findings of 123 Cases.

“…In the series of Botting et al consisting of 262 pediatric patients with periorbital infection, the frequency of preseptal cellulitis and orbital cellulitis were found 87% and 13% [5]. In studies performed in our country reported that the frequency of preseptal cellulitis is between 81% and 88.9%, the frequency of orbital cellulitis is between 11.9% and 19% in admitted children with periorbital infections [14,15]. The similarly ratio of preseptal cellulitis and orbital cellulitis detected in our study.…”

“…The age of the patients with orbital involvement was larger than that of the patients without orbital involvement in our study, but this difference was not statistically signi cant. Male gender was found to be more frequent in patients with or without orbital involvement [5,15]. While the male/female sex ratio was 1.4/1 in orbital involvement, it was 1.5/1 in our patients with preseptal cellulitis cases.…”

“…In a review of 16 studies included 180 cases with intracranial complications due to sinusitis in childhood period, reported that the frequency of complications were subdural empyema (49%), epidural abscess (36%), cerebbral abscess (21%) and meningitis (10%) [24]. MRI is the preferred method for detecting intracranial complications with MRI venography when cavernous sinus thrombosis is considered [7,15,20,21,25,26]. MRI is more sensitive in evaluating orbital and intracranial complications of sinusitis [25].…”

“…While sinusitis was detected in all orbital cellulitis group, it was found in approximately half of the preseptal cellulitis group. In the literature, it is reported that 75% of orbital infections are associated with sinusitis and most commonly with ethmoid sinusitis [15,[17][18][19]. However, there are also studies in which the incidence of sinusitis is lower in patients with preseptal cellulitis [5,14].…”

Demographic Characteristics of Orbital Cellulite Cases and Clinical Approach

“…Yapılan birçok çalışmada, başlangıç antibiyotik tedavisi olarak ampisilin-sulbaktam veya 3. kuşak sefalosporinlere klindamisin, metronidazol gibi anaeroplara etkili ajanların eklenmesiyle etkili bir tedavi sağlandığı vurgulanmıştır. 13,14 Benzer şekilde, bizim kliniğimizde de rutin olarak seftriakson ve metronidazol kombinasyonu uygulanmaktadır. Enfeksiyon hastalıkları kliniğinin önerisi doğrultusunda üç hastaya seftriakson, amikasin ve bir hastaya seftriakson, klindamisin tedavisi uygulanmıştır.…”