Review on periorbital and orbital cellulitis. A fifteen year's experience

Introduction: eye infections are frequent in children. The distinction between periorbital and orbital is essential because of its different prognosis. Early detection and treatment are important because they can produce serious complications.

Objective: to check the epidemiology, clinical symptoms and prognosis, microbiology, complications and periorbital/orbital cellulitis treatment in children younger than fifteen admitted into hospital due to this pathology.

Patients and methods: retrospective study of patients under 15 years hospitalized because of periorbital cellulitis from April of 1992 to December of 2006 in Getafe University Hospital. The clinical criterions followed to diagnose periorbital cellulitis were the presence of inflammatory signs in eye or periorbital soft tissues; including at least palpebral swelling and conjunctival injection. Signs like the disminution of visual acutennes, the alteration of the eye motility, chemosis, proptosis, alterations of the fundus examination and systemic symptoms orientated to orbital cellulitis. In doubtful cases, the location diagnosis was established by TAC.

Results: sixty six patients were included and thirty six (55%) were males. The median of the age was 38 months (rank: 3 months-14 years). The associated pathology was: conjunctivitis 26%, upper respiratory tract infections 42%, dental pathology 6%, local cutaneous trauma 12% and others 14%. Associated sinusitis was present in 19 of the 27 patients who underwent image technique. The more frequent pathogens considered were Staphylococcus aureus and Streptococcus pneumoniae, and with less frequency Haemophilus influenzae. All the patients received an intravenous antibiotic treatment: 36% with a single antibiotic (cefuroxime or amoxicillin-clavulanic acid) and 64% multiple antibiotic therapy, associating systemic corticosteroids in the 24% and local surgical treatment in the 7.5%. All the patients improved and they had not sequelae.

Conclusions: the periorbital/orbital cellulitis is a frequent and potentially serious process in pediatrics. It usually appears in children under four, and its association with sinusitis is frequent in older children. The efficiency of blood cultures is low compared to eye exudates. They usually have a favourable evolution with the resolution of the disease in the first 48 hours, except complication, with early diagnosis and treatment.