Bacterial periorbital and orbital cellulitis in childhood

The clinical features, microbiologic data, complications, and treatment in 137 children with periorbital cellulitis and 21 children with orbital cellulitis is presented. Periorbital cellulitis was more frequent (87%) than orbital cellulitis (13%). Periorbital cellulitis is a heterogeneous disease that may complicate trauma of the eyelids, external ocular infection, and upper respiratory infection. Children with periorbital cellulitis related to trauma or external infection tended to be less than 5 years old with negative blood cultures (99%) and positive cultures of percutaneous aspirates (42%); while children with periorbital cellulitis related to upper respiratory infection also tended to be less than 5 years of age, but blood cultures were frequently positive (42%) and cultures of percutaneous aspirates were usually negative (92%). Three children in the latter group developed meningitis. Intravenous antibiotic alone was effective treatment in most patients (90%). Orbital cellulitis was more frequent in children older than 5 years and frequently associated with sinusitis (90%). Blood and skin cultures were usually negative. Intravenous antibiotics alone were effective management in many patients (62%), but a significant proportion required paranasal sinus or orbital surgery (38%).