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Periorbital cellulitis
1Department of Surgery, Tripler Army Medical Center Honolulu, HI 96859-5000.
Insights
Routine lumbar puncture may not be necessary for children over 6 months with periorbital cellulitis. This study suggests CNS complications are rare, questioning the need for this invasive procedure in uncomplicated cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Periorbital cellulitis, a common sinusitis complication in children, sometimes prompts routine lumbar puncture.
- The necessity of lumbar puncture to rule out central nervous system (CNS) complications like meningitis is debated.
Purpose of the Study:
- To evaluate the association between periorbital cellulitis and CNS complications.
- To determine the necessity of routine lumbar puncture in children with periorbital cellulitis.
Main Methods:
- Retrospective review of medical records for 102 children admitted with periorbital cellulitis between 1975 and 1982.
- Analysis of documented CNS complications.
Main Results:
- Two cases of meningitis and one case of bilateral subdural effusions were identified.
- The incidence of CNS complications in seemingly uncomplicated periorbital cellulitis was low.
Conclusions:
- Routine lumbar puncture is likely not indicated for children aged 6 months and older presenting with uncomplicated periorbital cellulitis.
- Clinical judgment should guide the decision for lumbar puncture, avoiding unnecessary invasive procedures.
Abstract:
Periorbital cellulitis is a common complication of sinusitis in children. At some hospitals lumbar puncture is routinely done as part of the complete evaluation of children admitted with periorbital cellulitis. Presumably, the lumbar puncture is done to rule out meningitis which could be the result of extension of infection from the orbit to the central nervous system (CNS). However, the degree to which periorbital cellulitis is associated with CNS complication is not known and the necessity for routine lumbar puncture is questioned. Therefore, records of 102 children admitted to the Children's Hospital National Medical Center from 1975 to 1982 with the diagnosis of periorbital cellulitis were reviewed. There were two cases of meningitis and one case of bilateral subdural effusions. Review of the literature and the findings in this study suggests that routine lumbar puncture in seemingly uncomplicated cases of periorbital cellulitis probably is not indicated in children 6 months of age or older.