Sinusitis and the acute orbit in children

Area of Science:

• Ophthalmology
• Pediatric Infectious Diseases
• Otorhinolaryngology

Background:

• Acute orbital infection is an uncommon condition, frequently secondary to acute sinusitis.
• While it can affect any age, it is most prevalent in children.
• Potential severe outcomes include vision impairment, blindness, intracranial complications, and death.

Purpose of the Study:

• To document the clinical experience with acute orbital infections in children at a major pediatric hospital.
• To analyze the association between orbital sepsis and acute sinusitis in pediatric patients.
• To evaluate the complications and outcomes of pediatric orbital infections.

Main Methods:

• Retrospective review of hospital case notes.
• Data collected from 1973 to 1989 at the Royal Liverpool Childrens Hospital, Alder Hey.
• Inclusion criteria: children diagnosed with orbital sepsis.

Main Results:

• Sixty-eight children were identified with orbital sepsis; 30 had associated acute sinusitis.
• Orbital sepsis was consistently unilateral, with a predilection for the left side.
• Ten children experienced diplopia; four required surgical drainage of a sub-periosteal abscess. No serious complications were noted, though two children had persistent diplopia for 2-3 months.

Conclusions:

• Acute orbital infections in children, even when associated with sinusitis, can be managed without severe sequelae.
• Unilateral presentation is typical, and prompt recognition and management of complications like sub-periosteal abscesses are important.
• The study highlights a favorable outcome profile for pediatric orbital sepsis managed at the institution.