Predictors and clinical outcomes of surgical intervention in pediatric orbital cellulitis

To identify clinical and radiological features to better predict surgical intervention in pediatric orbital cellulitis (OC).

A retrospective study, including pediatric patients who had clinico-radiological evidence of bacterial orbital cellulitis. Patient demographics, orbital imaging, presence of orbital or subperiosteal abscesses (SPA), surgical and/or medical management, and outcomes were noted. Statistical analysis was conducted using independent samples t test and χ² tests with significance defined as p < 0.05.

Eighty-seven patients were diagnosed with OC between 2012 and 2024 (mean age 8.66 ± 4.34 years; range: 0.04-17 years). Surgical intervention was required in 59.8% (52/87). Associations were found with proptosis (p < .001), restricted ocular motility (p < .001), optic neuropathy (p = .037), orbital/SPA abscess (p < .001), and inflammatory markers (white cell count: p = .021; C-reactive protein: p = .047). The most common SPA location was medial (43/53, 81.1%), which was significantly associated with surgery (p < .001). In surgical cases, greater periosteal elevation of 6.0 ± 3.2 mm and anterior-posterior (AP) abscess length of 22.5 ± 8.1 mm was observed (p = .047 and p = .013, respectively). Mean time to surgery was 23.6 ± 20.7 hours (range: 1.6-92.7 hours), with 67.3% occurring within 24 hours. Surgical cases had longer hospital stays (7.82 vs 4.74 days; p < .001). Complete resolution occurred in 92.0% (80/87) of patients.

Proptosis, impaired ocular motility, and radiological evidence of abscess were found to be associated with surgical intervention in pediatric OC. Additionally, patients with a SPA surgery were more likely to have greater periosteal elevation and AP abscess length. Surgical intervention was found to be higher in this cohort than that documented in other literature.