Pediatric preseptal and orbital cellulitis: A 10-YEAR experience

Publication date: Available online 7 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Joana Caldeira Santos, Sara Pinto, Sofia Ferreira, Catarina Maia, Sandra Alves, Vinhas da Silva

Abstract

Objective

Characterize clinical features, epidemiology and treatment of hospitalized pediatric cases of preseptal and orbital cellulitis.

Methods

Retrospective study of children/adolescents admitted to a central hospital with preseptal and orbital cellulitis between 2007 and 2017.

Results

A total of 122 cases were included, 80.3% with preseptal cellulitis and 19.7% with orbital cellulitis. Patients had a median age of 5 years. Sinusitis was the most common predisposing factor (40.2%), followed by dental abscess (20.4%) in preseptal cellulitis and by external ocular infections (12.5%) in orbital cellulitis. Sinusitis (p<0.001) was associated with orbital cellulitis, whereas patients with dental abscess (p=0.007) and trauma (p=0.040) were most likely to have preseptal cellulitis. Fever, photophobia, ocular pain, painful eye movements, proptosis, rhinorrhea and vison impairment were related with orbital cellulitis. Leukocytosis was present in 34.4% of patients, and associated with orbital cellulitis (p=0.001). Nearly half of patients (49.2%) had a CT-scan performed. Systemic corticosteroids were used in 19.7%. Complications occurred in 13 patients. Imaging revaluation through CT was performed in 6.6%, with no patients showing deterioration; 1.6% of patients required surgery.

Conclusions

Identification of orbital involvement signs suggested orbital cellulitis. We emphasize the impact of dental abscess as a predisposing factor for preseptal cellulitis. Repeated imaging had no impact on treatment or outcome. A high percentage of patients was treated with steroids despite their controversial use.

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