Pediatric Preseptal Cellulitis: A 5-year Retrospective Study in an Iranian Referral Hospital

Preseptal cellulitis, the most common periorbital cellulitis manifestation, is more common in children. The aim of this cross-sectional study was to analyze the diagnosis and treatment of preseptal cellulitis infections in patients admitted to Children's Medical Center, an Iranian referral hospital, between 2015 and 2019.

The demographic characteristics of patients, symptoms at admission, affected eye (unilateral/ bilateral and right/left), the duration of symptoms and treatment, imaging findings, and the microbial culture were recorded from patient history and medical files.

During 5 years, 136 children with preseptal cellulitis, of whom 71 (52.2%) were boys and 65 (47.8%) were girls. The age range of the patients was between 9 days and 15 years, with a mean age of 41.9±39.3 months. All of the children had eyelid swelling and edema upon their initial visit. The most common accompanying symptoms in patients after edema and swelling of the eyelids were fever (41.2%), followed by eye discharge in 30.1%, and tenderness in 19.9% of patients. Ocular involvement was 51.5% in the right eye, 44.9% in the left eye, and 3.7% in both eyes. A CT scan was performed in 58 cases (42.6%), showing preseptal cellulitis in 29 patients (21.3%), followed by ethmoid sinusitis in 14 cases (10.3%). The most commonly used antibiotics, either alone or in combination, were clindamycin (72.8%, n=99), ceftriaxone (54.4%, n=74), vancomycin (27.2%, n=37), metronidazole (23.5%, n=32), and cefotaxime (17.6%, n=24).

Preseptal cellulitis in children presents with a spectrum of symptoms and is frequently associated with risk factors such as sinusitis, odontogenic infections, insect bites, or periocular trauma. Imaging, particularly CT, is essential for evaluating disease severity and identifying complications. One limitation of this study is the occurrence of negative culture results, which could be due to factors such as sample collection, transportation, or possible issues with the culture techniques.

According to this study, children with preseptal cellulitis might exhibit a variety of symptoms. The most common risk factors for preseptal cellulitis infection are sinusitis, odontogenic infections, animal or insect bites, and periocular trauma. Patients usually received clindamycin, ceftriaxone, and combination antibiotics.