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Pediatric preseptal and orbital cellulitis - a 6 year experience from a London tertiary centre
Allan Z Nghiem1, Blanca Sanz-Magallon Duque de Estrada1, Reem Farwana1
1Moorfields Eye Hospital, St George's Hospital, London, UK.
Insights
Pediatric orbital cellulitis, particularly subperiosteal abscess (SPA), often requires surgical intervention. Orbital surgeons are crucial for managing superior SPA cases, recommending multidisciplinary care.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Otorhinolaryngology
Background:
- Preseptal and orbital cellulitis are common pediatric infections.
- Subperiosteal abscess (SPA) is a frequent complication of orbital cellulitis.
- Management strategies vary, highlighting the need for specialized surgical input.
Purpose of the Study:
- To analyze the experience of pediatric preseptal and orbital cellulitis at a London tertiary center.
- To emphasize the role of orbital surgeons in managing SPA.
- To evaluate surgical outcomes and team involvement.
Main Methods:
- Retrospective review of pediatric patients hospitalized for preseptal and orbital cellulitis over six years.
- Data collection included clinical presentation, laboratory findings, and management details.
- Analysis of surgical interventions and the involvement of different surgical specialties.
Main Results:
- 49 cases of orbital cellulitis were identified, with 77.6% having SPA.
- Medial SPA was most common (81.6%), followed by superior SPA (28.9%).
- Orbital surgeons were involved in 54.5% of superior SPA cases, indicating a need for their expertise.
Conclusions:
- Superior SPA cases necessitate treatment at centers with both ENT and orbital surgeons.
- Multidisciplinary surgical teams improve outcomes for complex orbital infections.
- Orbital surgeon involvement is critical for specific SPA presentations.
Purpose:
This study reports the experience of pediatric preseptal and orbital cellulitis at a London tertiary centre during a 6-year period and highlights the role of orbital surgeons in the management of subperiosteal abscess (SPA).
Methods:
A retrospective review was conducted of all pediatric patients hospitalised for preseptal and orbital cellulitis.
Results:
A total of 201 children including 152 cases of preseptal cellulitis and 49 cases of orbital cellulitis were admitted at a London tertiary centre over the study period. Patients with orbital cellulitis and especially those managed surgically had higher rates of fever, higher presenting white cell count and C-reactive protein level compared to cases of preseptal cellulitis. 77.6% of patients with orbital cellulitis had SPA. 81.6% of SPA had a medial component, while 28.9% had superior component. 61.2% of orbital cellulitis cases were managed surgically. Surgical intervention was carried out by otorhinolaryngologists (ENT) in 76.7% of cases, jointly between ENT and orbital surgeons in 16.7% of cases and by orbital surgeons alone in 6.7% of cases. Of the 11 SPA involving the orbital roof, all were surgically managed and orbital surgeons were involved in 54.5% of cases. When SPA involved the medial wall, orbital surgeons were only involved in 6.5% of cases.
Conclusions:
We recommend all patients with superior SPA be treated at a centre with both ENT and orbital surgeons as these may not be amenable to drainage by ENT alone.
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