Periorbital Cellulitis in Paediatric Emergency Medicine Department Patients

Abstract

cellulitis is defined as an infection in front of the orbital septum of the eye and is characterised by development of acute eyelid oedema, tenderness, warmth, chemosis and erythema. [1][2][3] This is a relatively common condition seen in the paediatric population. 4 Periorbital cellulitis has to be promptly distinguished from orbital cellulitis which is an infection occurring posterior to the orbital septum. 5,6,7 Periorbital cellulitis is usually associated with concurrent local pathologies like chalazion, ethmoid sinusitis, dacrocystitis, facial cellulitis, facial or dental surgical procedures, periocular trauma, impetigo and insect bites. 1,8 A thorough history, meticulous clinical examination and identification of risk factors are paramount in the management of this condition. 9 Treatment is predominantly medical with initiation of prompt antibiotic therapy and addressing the underlying pathology. 2 The aim of this study was to describe the epidemiology, clinical profile and outcome of children with periorbital cellulitis attending the paediatric emergency medicine department. We also wanted to determine the correlation of clinical severity index score 10 with development of complications. Materials and MethodsThis was a single-centre retrospective study based on data collected at the Children's Emergency department at KK Women's and Children's Hospital (KKH), Singapore between 2006 and 2016. The study was approved by the SingHealth Centralised Institutional Review Board (CIRB). The data collection was started by identifying all patients with discharge diagnosis of periorbital cellulitis or preseptal cellulitis from the discharge diagnosis and then recording information on: demography, symptoms, aetiology, clinical signs, treatment, follow-up and return visit.Clinical severity index score was calculated for all individual patients by a score validated by Linda Vu et al 10 which included systemic features and local features. All categorical variables were analysed using chi-squared test, while for continuous variables, independent t-test was used. Following this, univariate and multivariate logistic regression analyses were performed, with periorbital cellulitis as the primary outcome.

Evaluation of mild periorbital cellulitis and home‐based therapy in children—EPOCH study: A prospective single centre cohort study

“…Retrospective studies have reported on the use and the safety of oral antibiotics for all grades of severity of POC. James et al reported 46.8% admission rate for 614 patients with POC who represented after being managed with oral antibiotics on an outpatient basis but this study lacked clarity in risk stratification of POC and the definition of mild POC 17 . Compared to this study, the current study had low admission rate (7%).…”

“…Based on the review of 18 out of 24 guidelines (two paediatric guidelines), the authors found that in 51 acute admitting otolaryngology units, that was lack of clarity on the inclusion of ophthalmology review in the guidelines 7 . Some have included daily temperature checks and daily ophthalmology assessment in their protocol 17 . We opted for daily ambulatory team review for the first 2 days after discharge and telephonic ophthalmology consultation (including sending a photograph of the affected eye to the ophthalmologist on call by the ambulatory care team) followed by face‐to‐face ophthalmology review on day 7.…”

“…Retrospective studies report on the safety and the efficacy of ambulatory management of mild POC with antibiotics and regular follow up 2,17 . However, there is lack of prospective evaluation of this approach.…”

Complications of Severe Odontogenic Infections: A Review

“…It is important to note that around 80% of orbital cellulitis and abscess cases are caused by bacterial rhinosinusitis. The minority of cases are caused by trauma, infections of the face, middle ear, tonsils, or teeth [ 41 , 42 ]. Odontogenic infections usually gain access to the orbit through the maxillary sinus and associated facial vasculature.…”

Frontal Mucopyocoele Presenting With Recurrent Periorbital Cellulitis: A Delayed Diagnosis

“…Periorbital cellulitis (also called pre-septal cellulitis) is an acute infection of the periorbital soft tissues, largely the eyelids, skin and soft tissues anterior to the orbital septum [1]. Patients present with unilateral eyelid swelling and oedema [2]. The infection can start from a primary skin, conjunctival or sinus origin, and may in turn progress beyond the orbital septum posteriorly as orbital cellulitis.…”