[Four cases of severe orbital cellulitis in children]

Area of Science:

• Ophthalmology
• Pediatric Infectious Diseases
• Bacteriology

Background:

• Orbital cellulitis is a serious eye condition in children, characterized by inflammation of orbital tissues posterior to the orbital septum.
• Prompt diagnosis and management are crucial to prevent severe complications, including vision loss and intracranial spread.
• Bacterial infections are a common cause, with specific pathogens identified in severe pediatric cases.

Purpose of the Study:

• To report on four pediatric cases of severe orbital cellulitis.
• To highlight the clinical presentation, causative pathogens, and treatment outcomes.
• To emphasize the importance of timely and aggressive management in severe orbital cellulitis.

Main Methods:

• Retrospective case series of four children treated for severe orbital cellulitis.
• Clinical data collection including symptoms, physical examination, laboratory tests (blood routine, bacterial cultures), and orbital imaging.
• Treatment involved systemic and ocular antibiotics, local debridement, and abscess incision and drainage.

Main Results:

• All patients presented with severe symptoms, elevated inflammatory markers (CRP > 140 mg/L, WBC > 20×10^9/L), and positive bacterial cultures (e.g., Streptococcus pyogenes, Acinetobacter baumannii, MRSA, Pseudomonas aeruginosa).
• Orbital imaging revealed orbital abscess (Chandler stage 4) or subperiosteal abscess with necrotizing fasciitis (Chandler stage 3).
• All children recovered with appropriate treatment; two required corrective surgery for late-onset deformities.

Conclusions:

• Severe orbital cellulitis in children is associated with significant inflammation and specific bacterial pathogens.
• Aggressive medical and surgical management is effective in achieving recovery.
• While generally successful, long-term sequelae like cosmetic deformities may necessitate further surgical intervention.