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Clinical Outcomes in Children With Orbital Cellulitis and Radiographic Globe Tenting
Rebecca A Lindsay1,2, Avery H Weiss1,2, John P Kelly1,2
1Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington.
Insights
Pediatric orbital cellulitis with globe tenting does not appear to cause severe vision loss. Children with this condition showed better visual outcomes than adults, possibly due to increased ocular elasticity.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Medical Imaging
Background:
- Globe tenting, characterized by axial globe displacement at the optic nerve-globe junction, is linked to vision loss in adults.
- Orbital cellulitis is a serious infection requiring prompt diagnosis and management.
Purpose of the Study:
- To investigate the visual outcomes in children diagnosed with orbital cellulitis and concurrent globe tenting.
- To compare pediatric outcomes with known adult prognoses.
Main Methods:
- Retrospective review of 46 pediatric orbital cellulitis cases at a tertiary children's hospital.
- Globe tenting defined by optic nerve-globe junction angle (≤130°) on CT/MRI.
- Comparison of visual acuities (logarithm of the minimum angle of resolution) between children with and without globe tenting.
Main Results:
- Patients with globe tenting exhibited a smaller posterior globe angle (124.5°) compared to those without (145.6°).
- Final visual acuity was excellent (logarithm of the minimum angle of resolution = 0) in children with globe tenting post-treatment.
- No significant difference in final visual acuity was observed between children with and without globe tenting (logarithm of the minimum angle of resolution = 0.02).
Conclusions:
- Pediatric orbital cellulitis with globe tenting may not result in severe vision loss.
- Increased ocular elasticity in children might contribute to favorable visual outcomes.
- Findings suggest a potentially better prognosis for globe tenting in pediatric patients compared to adults.
Purpose:
Axial displacement of the globe with tenting centered on the optic nerve-globe junction is a predictor of visual loss in adults. The purpose of this study was to determine the visual outcomes of children with orbital cellulitis and globe tenting.
Methods:
The records of 46 consecutive children with orbital cellulitis at a single tertiary children's hospital were reviewed retrospectively. Initial and final visual acuities were available for 34 of 46 patients (74%). Globe tenting was defined by an angle of 130° or less at the optic nerve-globe junction as derived from sagittal CT or MRI. Visual acuities of 4 children with globe tenting (mean age, 10.3 ± 3.3 years) were compared with those of 30 children without globe tenting (mean age, 10.8 ± 3.5 years). Final logarithm of the minimum angle of resolution visual acuities were analyzed.
Results:
The mean posterior globe angle was 124.5° ± 8.0° in patients with globe tenting, compared with 145.6° ± 7.4° in the affected eye of the patients without globe tenting (p = 0.002). Final visual acuity was logarithm of the minimum angle of resolution = 0 following treatment in patients with globe tenting and logarithm of the minimum angle of resolution = 0.02 in patients without tenting (p = 0.70).
Discussion:
We propose that the increased elastic compliance of the optic nerve sheath and sclera in children may contribute to better visual outcomes.
Conclusions:
Pediatric orbital cellulitis with globe tenting may not lead to devastating vision loss as previously seen in adults.
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