Abstract and Introduction
Abstract
Background: To review the epidemiology and management of orbital cellulitis in children.
Methods: The medical records of children ≤18 years old and hospitalized from June 1, 1992, through May 31, 2002, at the Brenner Children's Hospital, with a discharge ICD-9 code indicating a diagnosis of orbital cellulitis and confirmed by computed tomography scan were reviewed. A literature search for additional studies for systematic review was also conducted.
Results: Forty-one children with orbital cellulitis were identified. The mean age was 7.5 years (range, 10 months to 16 years), and 30 (73%) were male (male:female ratio = 2.7). All cases of orbital cellulitis were associated with sinusitis; ethmoid sinusitis was present in 40 (98%) patients. Proptosis and/or ophthalmoplegia was documented in 30 (73%), and 34 (83%) had subperiosteal and/or orbital abscesses. Twenty-nine (71%) had surgical drainage and 12 (29%) received antibiotic therapy only. The mean duration of hospitalization was 5.8 days. The mean duration of antibiotic therapy was 21 days.
Conclusions: Orbital cellulitis occurs throughout childhood and in similar frequency among younger and older children. It is twice as common among males as females. Selected cases of orbital cellulitis, including many with subperiosteal abscess, can be treated successfully without surgical drainage.
Introduction
Orbital cellulitis is a serious infection in children that can result in significant complications, including blindness, cavernous sinus thrombosis, meningitis, subdural empyema, and brain abscess. These complications have become rare in the antibiotic era, but the potential for sight- or life-threatening complications makes prompt diagnosis and early treatment important.
The orbital septum divides the soft tissues of the eyelid (preseptal space) from those of the orbit (postseptal space). Periorbital (preseptal) cellulitis occurs anterior to the orbital septum and results from trauma, contiguous infection or primary bacteremia among young infants. In orbital cellulitis, the infection is localized posterior to the orbital septum and usually occurs as a complication of acute or chronic sinusitis.
The last major review of orbital cellulitis in the pediatric literature was published in 1987. This review described a case series from the Dallas area, with a mean of age of 12 years. In the mid-1990s, we treated several infants and preschool-age children with orbital cellulitis, which raised the question of whether a shift toward younger age among children with orbital cellulitis was occurring. The one series of orbital cellulitis in the pediatric literature since 1987 described good clinical outcomes with medical management alone in 9 children <5 years old. Recent case series in the otolaryngology and ophthalmology literature also have documented substantial proportions of orbital cellulitis cases among young children.
In an effort to explore potential epidemiologic changes and management trends in children with orbital cellulitis, we report our experience with 41 children in a 10-year period and review other case series of orbital cellulitis in children published since 1986.