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Paediatric periorbital cellulitis: A 10-year retrospective case series review
Declan C Murphy1,2,3, Sheneen Meghji1, Mohamed Alfiky1,4
1Ear, Nose and Throat Department, Norfolk and Norwich University Hospital, Norwich, United Kingdom.
Insights
Predictors of poor outcome in pediatric periorbital cellulitis include ophthalmoplegia, proptosis, and eye movement pain. Prompt imaging and surgical intervention are crucial for severe cases to prevent sight-threatening complications.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Surgical Management
Background:
- Periorbital cellulitis in children requires careful management to prevent severe complications.
- Identifying predictors of poor outcomes is essential for timely intervention.
Purpose of the Study:
- To identify predictors of poor outcomes and the need for surgery in pediatric periorbital cellulitis.
- To evaluate adherence to local management guidelines.
Main Methods:
- Retrospective analysis of 175 pediatric periorbital cellulitis cases over 10 years.
- Clinical, laboratory, and radiological data were analyzed.
- Regression analysis identified predictors of disease severity and surgical need.
Main Results:
- Increasing C-reactive protein levels correlated with higher risk of post-septal disease and surgery.
- Ophthalmoplegia, proptosis, and pain on eye movement predicted post-septal disease.
- Proptosis was the strongest predictor for requiring surgical intervention.
Conclusions:
- Multidisciplinary care and early medical management improve outcomes for most pediatric periorbital cellulitis cases.
- Prompt imaging and surgical consideration are vital for patients deteriorating despite medical treatment.
- Early intervention can prevent life- and sight-threatening complications.
Aim:
To identify the predictors of poor outcome and need for surgical management in paediatric patients with periorbital cellulitis. To assess the adherence to local guidelines in the management of periorbital cellulitis.
Methods:
Retrospective descriptive analysis of clinical, laboratory and radiological characteristics of 175 paediatric periorbital cellulitis presentations at a UK teaching hospital over a 10-year period. Regression investigated correlations for continuous and categorical variables.
Results:
A total of 175 paediatric presentations were diagnosed as periorbital infections over the 10-year period. Of these, 139 had pre-septal cellulitis, 27 had a subperiosteal abscess, 6 had an orbital cellulitis, 1 had an orbital abscess, 1 a cavernous sinus thrombosis and 1 an extradural abscess. Median age at presentation was 5 years (range: 1 month-17 years). In total, 169 (97%) cases received systemic antimicrobial treatment. Cross-sectional imaging occurred in 30% of cases and 18% required surgical intervention. Increasing C-reactive protein was associated with greater risk of post-septal disease and requiring surgery. The best predictors of post-septal disease in the multivariate analysis (R2 = 0.49, P = ≤0.001) were ophthalmoplegia (P = 0.009), proptosis (P = 0.016) and pain on eye movement (P = 0.046). Proptosis was the single most significant predictor of surgical management (R2 = 0.53, P = <0.001).
Conclusion:
Multidisciplinary involvement and early medical management can improve outcomes for most patients. Those who deteriorate despite medical management should be considered for prompt imaging and surgical management to avoid serious life-threatening or sight-threatening complications.
