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Paediatric periorbital and orbital infections: a decade of experience at Christchurch Hospital
Samuel Tomkins1, Tony Walls2, Hayleigh Miller3
1University of Otago Christchurch.
Insights
Paediatric periorbital and orbital infections are common, with sinusitis a key risk factor for orbital cellulitis. Māori and Pacific children are disproportionately affected, highlighting health inequities.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Paediatric Health
Background:
- Periorbital and orbital infections in children require prompt diagnosis and management.
- Understanding the epidemiology and microbiology is crucial for effective treatment strategies.
Purpose of the Study:
- To describe the epidemiology, clinical features, microbiology, and management of paediatric periorbital and orbital infections.
- To identify risk factors and disparities in affected populations.
Main Methods:
- Retrospective review of paediatric patients (<18 years) admitted with periorbital or orbital infections from 2013-2023.
- Data extracted from electronic medical records, including clinical, demographic, and microbiological information.
- Descriptive analysis of collected data.
Main Results:
- 495 paediatric cases identified; 93% periorbital cellulitis, 7% orbital cellulitis.
- Sinusitis was the primary predisposing factor for orbital cellulitis (83%).
- Staphylococcus aureus was the most common pathogen; Māori and Pacific children were disproportionately affected.
Conclusions:
- Orbital signs necessitate urgent imaging to rule out orbital disease.
- Sinusitis is a significant risk factor for orbital cellulitis.
- Health disparities exist, with disproportionate impact on Māori and Pacific children.
Aim:
This study aims to describe the epidemiology, clinical features, microbiology and management of paediatric patients (<18 years) admitted to Christchurch Hospital with periorbital or orbital infections over a 10-year period.
Methods:
A retrospective review was conducted of all patients under 18 years admitted with periorbital and orbital infections between 2013 and 2023. Cases were identified using surgical theatre records and discharge coding, with data extracted from electronic medical records. Clinical, demographic, microbiological and management data were analysed descriptively.
Results:
A total of 495 paediatric cases were identified, with 93% presenting with periorbital cellulitis and 7% with orbital cellulitis. Sinusitis was the predominant predisposing factor for postseptal disease, present in 83% of those cases. Orbital signs such as proptosis, pain with eye movement, reduced visual acuity and ophthalmoplegia were more frequent in orbital cellulitis. Orbital cases had longer hospital stays with a median of 4.5 days (range 2-33 days) compared to periorbital disease with a median of 1 day (range 0-8 days). Orbital cases also had a higher rate of surgical intervention (47%), most commonly functional endoscopic sinus surgery. Staphylococcus aureus was the most frequently isolated organism in both groups (45% periorbital, 42% orbital). Māori and Pacific children were disproportionately affected (comprising 20% and 10% respectively of periorbital cases and 17% and 19% of orbital cases).
Conclusions:
The presence of orbital signs should prompt urgent imaging to exclude orbital disease. Sinusitis remains a key risk factor for orbital cellulitis, and Māori and Pacific children are disproportionately affected.
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