Orbital cellulitis

Meara DJ. Sinonasal disease and orbital cellulitis in children. Oral Maxillofac Surg Clin North Am. 2012 Aug;24(3):487-96. 

Sinonasal disease is common in the pediatric population because of anatomic, environmental, and physiologic factors. Once paranasal sinusitis develops, orbital cellulitis is a concerning sequela that can result in loss of visual acuity and even intracranial disease. Thus, a clear history and physical examination in conjunction with radiographic studies are critical to a correct diagnosis and timely institution of treatment that may include hospitalization, serial ophthalmologic examinations, intravenous antibiotics, and surgery. The serious nature of orbital cellulitis in children cannot be overestimated; but, if prompt and appropriate treatment is initiated, the prognosis is excellent and long-term sequelae should be limited.

Full-text for Children’s and Emory users.

Bedwell J, Bauman NM. Management of pediatric orbital cellulitis and abscess. Curr Opin Otolaryngol Head Neck Surg. 2011 Dec;19(6):467-73.

“Orbital cellulitis and abscess formation in pediatric patients usually arises as a complication of acute sinusitis and if untreated may cause visual loss or life-threatening intracranial complications. This review describes the current evaluation and management of this condition.

Computed tomography with contrast remains the optimal imaging study for orbital inflammation. Orbital inflammation is still classified by Chandler’s original description as preseptal or postseptal and nearly all cases of preseptal cellulitis are managed with oral antibiotics. Most cases of postseptal cellulitis are managed with intravenous antibiotics, although surgical therapy is required for some abscesses, particularly large ones. Patients under 9 years respond to medical management more frequently than older patients but recent studies confirm that even children over 9 with small or moderate-sized abscesses and normal vision deserve a medical trial before surgical intervention. Medial subperiosteal abscesses that fail medical therapy are usually drained endoscopically, whereas lateral or intraconal abscesses require an open procedure.”

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Hauser A, Fogarasi S. Periorbital and orbital cellulitis. Pediatr Rev. 2010 Jun;31(6):242-9.

After completing this article, readers should be able to:

  1. Recognize the difference between periorbital and orbital cellulitis on the basis of history and physical examination findings.
  2. Describe the cause, pathophysiology, and management of periorbital and orbital cellulitis.
  3. Understand the importance of sinus disease in both periorbital and orbital cellulitis.Know the indications for computed tomography scan and specialist consultation for eyelid swelling.
  4. Recognize the complications of periorbital and orbital cellulitis.

Full-text for Children’s users.

Brook I. Microbiology and antimicrobial treatment of orbital and intracranial complications of sinusitis in children and their management. Int J Pediatr Otorhinolaryngol. 2009 Sep;73(9):1183-6.

This review describes the microbiology, and medical management of orbital and intracranial complications of sinusitis in children. The most common complications are orbital cellulitis, subperiosteal abscess, orbital abscess, brain abscess, subdural empyema and meningitis. The predominate organisms recovered from these infection are anaerobic, aerobic, and microaerophilic bacteria of oral flora origin. Establishing the microbiology by obtaining appropriate cultures for both aerobic and anaerobic bacteria are essential for proper antimicrobial selection. Early recognition and appropriate surgical and medical therapy are essential to ensure recovery.

Full-text for Children’s and Emory users.

Vairaktaris E, Moschos MM, Vassiliou S, et al. Orbital cellulitis, orbital subperiosteal and
intraorbital abscess: report of three cases and review of the literature. J Craniomaxillofac Surg. 2009 Apr;37(3):132-6. 

INTRODUCTION: Orbital cellulitis is usually a complication of paranasal sinus infection. Either the infection may dissect under the periosteum and lead to subperiosteal abscess (SPA) or intraorbital abscess may be formed secondary to a progressive and localized cellulitis. Without appropriate treatment orbital infection may lead to serious complications, even death.

REPORT OF CASES: Three cases are described, one of orbital cellulitis, one of SPA and one of intraorbital abscess and the literature is being reviewed.

CONCLUSION: Prompt treatment is mandatory to avoid visual loss or intracranial complications. Initially, IV antibiotics may be administered, but if no improvement appears within 48h, surgical drainage of the orbit and the affected sinuses must be performed. In medial or medial-inferior SPA a transnasal approach is used, but in superior orbital abscess an external incision is required.

Full-text for Children’s and Emory users.

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