Paediatric periorbital cellulitis: A 10‐year retrospective case series review

Abstract

Aim To identify the predictors of poor outcome and need for surgical management in paediatric patients with periorbital cellulitis. To assess the adherence to local guidelines in the management of periorbital cellulitis. Methods Retrospective descriptive analysis of clinical, laboratory and radiological characteristics of 175 paediatric periorbital cellulitis presentations at a UK teaching hospital over a 10‐year period. Regression investigated correlations for continuous and categorical variables. Results A total of 175 paediatric presentations were diagnosed as periorbital infections over the 10‐year period. Of these, 139 had pre‐septal cellulitis, 27 had a subperiosteal abscess, 6 had an orbital cellulitis, 1 had an orbital abscess, 1 a cavernous sinus thrombosis and 1 an extradural abscess. Median age at presentation was 5 years (range: 1 month–17 years). In total, 169 (97%) cases received systemic antimicrobial treatment. Cross‐sectional imaging occurred in 30% of cases and 18% required surgical intervention. Increasing C‐reactive protein was associated with greater risk of post‐septal disease and requiring surgery. The best predictors of post‐septal disease in the multivariate analysis (R2 = 0.49, P = ≤0.001) were ophthalmoplegia (P = 0.009), proptosis (P = 0.016) and pain on eye movement (P = 0.046). Proptosis was the single most significant predictor of surgical management (R2 = 0.53, P = <0.001). Conclusion Multidisciplinary involvement and early medical management can improve outcomes for most patients. Those who deteriorate despite medical management should be considered for prompt imaging and surgical management to avoid serious life‐threatening or sight‐threatening complications.

Cellulitis in children: a retrospective single centre study from Australia

“…This management is supported in the literature, which suggests that multidisciplinary management and early intervention can improve outcomes for children with periorbital cellulitis. 23 Canadian data have also demonstrated over-representation of facial cellulitis among paediatric inpatients (26.8%) compared with non-admitted patients (16.3%) with cellulitis. 24 Similarly, Canadian ED presentations were also predominantly extremity cellulitis (69.5%), due to insect bite (21.6%) and trauma (20.3%).…”

Preseptal and Orbital Cellulitis: Thirteen Years of Experience and a Novel Scoring System (SNIPPED Score) for Differentiation

“…The orbital surgery rate in the current study was 28.5% in the OC group and 2.6% overall. In a study which evaluated 175 pediatric cases (36 had OC), 27 patients had subperiosteal abscess and surgery was needed in 31 (1.7%) of all patients [10]. Another study found the rates of surgical intervention as follows: 29% overall (n = 93), 48.7% in the 39 patients with OC and 14.8% in the 54 patients with PC.…”

“…OC), and all patients with OC had sinusitis as a predisposing factor [9]. A recently published study reported that 68% of pediatric PC and OC cases had respiratory tract infection or sinusitis [10]. In a retrospective cross-sectional study from a tertiary ophthalmology hospital including 93 pediatric and adult patients (39 OC and 54 PC), it was reported that sinusitis was the most common etiology in both groups and was signi cantly more frequent in the OC group [11].…”

“…Although in ammatory parameters are elevated in both PC and OC, the absolute levels of acute phase reactants may be helpful in clinical practice [12]. For instance, higher CRP levels were reported to be associated with post-septal disease in a recent study [10]. NLR is a parameter which is studied in bacterial infections such as neonatal sepsis, urinary tract infection and community acquired pneumonia [13][14][15].…”

Antibiotic Choices for Pediatric Periorbital Cellulitis—A 20-Year Retrospective Study from Taiwan

“…Periorbital cellulitis is categorized as either preseptal or orbital cellulitis, which are defined as infections of the subcutaneous tissue anterior to the orbital septum and soft tissue posterior to the septum, respectively [ 1 , 2 , 3 ]. Recent studies on periorbital cellulitis in children have focused mainly on patient characteristics, clinical presentations, laboratory findings, and treatment effectiveness [ 1 , 2 , 3 , 4 , 5 , 6 ]. For example, a higher incidence of orbital cellulitis in males over females has been reported [ 7 ], and pediatric preseptal cellulitis is more common in younger patients than orbital cellulitis [ 1 , 2 , 4 ].…”