Pediatric Preseptal and Orbital Cellulitis: A Comparative Study of Clinical, Radiologic, and Laboratory Features

This study aimed to evaluate and compare the clinical, laboratory and radiologic characteristics, as well as treatment approaches, in pediatric patients diagnosed with preseptal and orbital cellulitis.

This descriptive, retrospective, cross-sectional study included pediatric patients treated at a tertiary care center between January 2019 and December 2023. Demographic, clinical, etiologic, laboratory and radiologic data were analyzed.

Among 244 patients, 233 (95.5%) had preseptal cellulitis and 11 (4.5%) had orbital cellulitis. There were no significant differences in age and gender between the groups ( P = 0.465 and P = 0.274, respectively). Fever (81.8%), proptosis (54.5%), pain with eye movements (54.5%) and diplopia (18.2%) were significantly more frequent in orbital cellulitis ( P < 0.05). Sinusitis was detected in all patients with orbital cellulitis ( P = 0.001), while conjunctivitis was the leading etiologic factor in preseptal cases (28.3%). Leukocyte and C-reactive protein levels were significantly higher in orbital cellulitis patients ( P = 0.001). All patients underwent computed tomography; subperiosteal abscess was identified in 5 (2%), orbital abscess in 1 (0.4%) and epidural abscess in 1 (0.4%) patient. Surgery was required in 54.5% of orbital cellulitis cases. No permanent complications were observed in either group.

Preseptal cellulitis is more common and typically follows a milder clinical course. In contrast, orbital cellulitis, although rare, presents with more severe symptoms and elevated inflammatory markers. Radiologic imaging plays a key role in the diagnostic process, complementing clinical assessment. The consistent association of sinusitis with orbital cellulitis highlights the importance of early recognition and treatment of sinus infections to prevent serious complications.