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Management of periorbital cellulitis at the Pediatric Emergency Department: A ten years study
W Lahmini1, M Oumou1, M Bourrous1
1Department of Paediatric Emergency, Mohamed VI University Hospital, Cadi Ayyad University, Marrakech, Morocco.
Insights
Periorbital cellulitis, an infection around the eye, requires prompt treatment. This study found that early diagnosis and appropriate antibiotics led to good outcomes in most pediatric cases, with surgery rarely needed.
Area of Science:
- Ophthalmology
- Pediatric Emergency Medicine
- Infectious Diseases
Background:
- Periorbital cellulitis is a serious condition that can impact vision and survival.
- Prompt diagnosis and treatment are crucial for managing periorbital cellulitis.
Purpose of the Study:
- To analyze the epidemiological characteristics of periorbital cellulitis in children.
- To evaluate the therapeutic approaches and outcomes for pediatric periorbital cellulitis.
- To identify factors influencing the prognosis of periorbital cellulitis in a pediatric emergency setting.
Main Methods:
- A 10-year retrospective study (2010-2019) of children aged 1 month to 15 years treated for periorbital cellulitis.
- Inclusion of all cases managed in the Pediatric Emergency Department of Mohamed VI University Teaching Hospital, Marrakech.
- Data collection included demographics, clinical presentation, diagnostic imaging (orbital CT scans), treatment, and outcomes.
Main Results:
- 168 cases of periorbital cellulitis were recorded, with a notable increase from 2010 to 2019.
- The most affected group was children under 5 years (62.5%), with sinusitis as the most common entry point (22%).
- Preseptal cellulitis was more frequent (76.7%) than orbital cellulitis (8.3%). Orbital CT revealed subperiosteal abscess in 12% and orbital abscess in 3% of cases. Amoxicillin-clavulanic acid was the primary antibiotic. Most patients (87.1%) had good outcomes with medical and/or surgical treatment, with no long-term complications observed.
Conclusions:
- The majority of pediatric periorbital cellulitis cases achieve positive outcomes.
- Early diagnosis, appropriate antibiotic therapy, and multidisciplinary care are key to successful management.
- Surgery is infrequently required for periorbital cellulitis when timely and effective treatments are implemented.
Abstract:
Periorbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the prognosis for vision and survival.
Purpose:
The goal of this study was to analyze the epidemiological and therapeutic features and outcomes of periorbital cellulitis cases treated in the pediatric emergency department.
Patients And Methods:
A retrospective study including all the children aged between 1 month and 15 years treated for periorbital cellulitis in the Pediatric Emergency Department of the Mohamed VI University Teaching Hospital in Marrakech over a period of 10 years (January 1, 2010-December 31, 2019).
Results:
In all, 168 cases of periorbital cellulitis were recorded, with an increasing of the number of cases, from 2 in 2010 to 39 in 2019. The most affected age bracket was the group under 5 years of age (62.5%). The most frequent mode of entry was sinusitis (22%). Preseptal cellulitis was most common (76.7%). The main clinical signs found in orbital cellulitis were proptosis (64%) and chemosis (35.8%), versus conjunctival hyperemia (78%) in preseptal cellulitis. Ophthalmoplegia was present in two cases of orbital cellulitis. The right side was most affected (44%). An orbital CT scan was performed in all cases in our study, showing preseptal cellulitis in 129 patients (76.7%), orbital cellulitis in 14 cases (8.3%), subperiosteal abscess in 20 cases (12%) and orbital abscess in 5 cases (3%). Prior treatment with non-steroidal anti-inflammatory medication was noted in 6%. The most commonly used antibiotic was amoxicillin-clavulanic acid. Steroid treatment was prescribed in 6% of cases. Surgical treatment was indicated in 12 patients (7.1%). The mean hospital length of stay was 3 days for the preseptal cases and 8 days for the orbital cases. All patients had good outcomes with medical and/or surgical treatment. With follow-up of over one year, no complications were noted.
Conclusion:
The majority of our cases had positive outcomes, highlighting the advantage of early diagnosis, adapted antibiotic treatment and multidisciplinary care, rendering surgery rarely necessary.
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