Paediatric periorbital cellulitis and its management

Periorbital cellulitis is often difficult to distinguish from orbital cellulitis, which is a rare but potentially fatal disease. There are only a few small studies in the literature and we aim to look at an ideal way of managing periorbital cellulitis in a paediatric population using our department's experience.

Retrospective analysis of case notes and computer records of children attending our hospital with periorbital cellulitis over 26 month period.

Thirty-four patients met the criteria. Sixteen patients had reduced visual acuity, proptosis or ophthalmoplegia. Twenty-three had white cell count checked, 14 were raised and 7 of these had an operation. Eleven had blood cultures checked and all were negative. Seven had other cultures taken, Streptococcus milleri was the predominant organism isolated. Sixteen were CT scanned, 14 showed significant sinus disease. All patients were treated with intravenous antibiotics and ten required operative intervention. Two patients developed lateral orbital collections requiring further surgery.

Although relatively rare, periorbital cellulitis can be dangerous and it is essential for it to be treated seriously. A multidisciplinary approach is needed in managing children with this condition, with a good history and full blood count assisting in assessing severity, but a CT scan of the patient's sinuses is essential to differentiate from orbital cellulitis.