Related Experiment Video
Updated: Dec 25, 2025
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Factors Associated With Increased Risk of Pediatric Orbital Cellulitis-Who Should Be Scanned?
Lea Ohana-Sarna-Cahan1, Noa Hurvitz2, Itai Gross3
1From the Department of Pediatrics.
Insights
Differentiating preseptal (POC) and orbital cellulitis (OC) in children is crucial. This study found C-reactive protein levels and neutrophil-to-lymphocyte ratio are key indicators for assessing pediatric eye infections.
Area of Science:
- Ophthalmology
- Pediatric Emergency Medicine
- Infectious Diseases
Background:
- Evaluating pediatric preseptal (POC) and orbital cellulitis (OC) presents challenges due to physical examination difficulties and risks associated with CT scans.
- Accurate differentiation is vital for appropriate management and preventing complications.
Purpose of the Study:
- To compare clinical and laboratory findings between pediatric POC and OC.
- To identify key indicators for differentiating between these two conditions.
- To develop a risk calculator for orbital cellulitis.
Main Methods:
- Retrospective review of children aged 0-16 years diagnosed with POC/OC between 2009 and 2019.
- Analysis of presenting symptoms, physical examination findings, laboratory tests (leukocyte count, neutrophil count, lymphocyte count, C-reactive protein, erythrocyte sedimentation rate), and CT scan results.
- Formulation of a risk calculator based on significant variables.
Main Results:
- Orbital cellulitis (OC) was diagnosed in 20.6% of the 243 pediatric patients.
- OC presented with higher rates of fever, upper respiratory tract infection, eyelid swelling, proptosis, and tenderness compared to POC.
- Elevated C-reactive protein, higher leukocyte and neutrophil counts, and a specific neutrophil-to-lymphocyte ratio (NLR) were significantly associated with OC.
Conclusions:
- Distinguishing between POC and OC in children is essential for effective treatment.
- Ancillary laboratory tests, particularly C-reactive protein and NLR, play a significant role in assessing the severity and type of pediatric eye infections.
- A risk calculator incorporating six major variables was developed to aid in OC assessment.
Background:
Evaluation of a child with POC/OC is complicated due difficulties in physical examination and risks of imaging by computed tomography.
Method:
Retrospective review of children 0-16 years admitted to the pediatric emergency department for POC/OC from 2009 to 2019.
Results:
Ten years study period, 243 children younger than 16 years presented to the pediatric emergency department with a diagnosis of POC/OC. OC was documented in 51 (20.6%) patients. The mean age was 7.8 years (±4.3 years). Fever (80.4%), upper respiratory tract infection (43%), swelling of both eyelids (96%), proptosis (33.3%), and tenderness on percussion (24.5%) were more common in comparison to POC (P = 0.0001, 0.03, 0.0001, 0.0001, 0.0001 respectively). All children with suspected diagnosis of OC underwent computed tomography scan. POC accounted for 196 patients. Mean age was 4.6 (±4.3) years. Twenty percent of the cases were recorded as local trauma or insect bite in the infected eye.Mean leukocyte count in the OC group had higher mean of 15.2 (109/L) versus 13.4(109/L) (P = 0.05), absolute neutrophil count was significantly higher in the OC 11.3(109/L) versus 7.2(109/L) (P = 0.0001) whereas the lymphocyte count was higher in the POC 4.5(109/L) versus 2.4(109/L) (P = 0.0001), NLR of 0.318 correlates with orbital cellulitis with sensitivity of 75.5% and specificity of 77.4%.Patients with OC had mean C-reactive protein levels of 11.7 (mg/dL) versus 4.9(mg/dL) (P = 0.0001), erythrocyte sedimentation rate was elevated in the OC 53.6 (cm/h) versus 36.4 (cm/h) (P = 0.02).Based on the aforementioned study a risk calculator for OC was formulated with 6 major variables.
Conclusions:
Differentiation between POC/OC is cardinal. This study highlights the importance of ancillary laboratory tests especially C-reactive protein in the assessment of infections of the eye.
Related Concept Videos
01:30Radiological Investigation I: X-ray and CT
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...