Considerations in the management of a paediatric patient with recurrent periorbital cellulitis

Periorbital cellulitis with subperiosteal orbital abscess (SPOA) is a common presentation to paediatric ear, nose and throat services. Recurrent cases are rare but pose significant therapeutic challenges.We present the case of a boy in early childhood with recurrent left periorbital cellulitis and SPOA formation, which required three surgical procedures. The third procedure was performed endoscopically due to the abscess being sited posteriorly towards the orbital apex. Following this, he recovered well with no residual deficiencies to his vision. This impact was sustained over a 12-month period.This case highlights the importance of a full assessment along the lamina papyracea to minimise risk of recurrence. A defect in the lamina can provide a direct route of spread for pus and scarring around the anterior orbit from previous surgery can limit tissue compliance, resulting in an increased risk of visual compromise. In these cases, early operative intervention should be considered.