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[Periorbital and orbital cellulitis in children]
1Hvidovre Hospital, Børneafdelingen, København.
Insights
Febrile children with periorbital swelling often present with confusing symptoms. Imaging like CT or MR scans are crucial for diagnosing preseptal and postseptal cellulitis, guiding treatment effectively.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Context:
- Acute periorbital swelling in febrile children can be challenging to diagnose.
- Distinguishing between preseptal and postseptal cellulitis is critical for appropriate management.
Purpose:
- To analyze the clinical presentation, diagnosis, and management of febrile children with acute periorbital swelling.
- To evaluate the utility of imaging techniques in differentiating preseptal and postseptal cellulitis.
Summary:
- A retrospective study identified 28 febrile children with acute periorbital swelling.
- Children were classified as having preseptal cellulitis (n=11) or postseptal cellulitis (n=15) due to paranasal sinus infections (ethmoiditis).
- Diagnosis was confirmed via clinical presentation, cultures, or CT/MR scans; all children received antibiotics, with four requiring surgery. Imaging proved most helpful in identifying surgical candidates.
Impact:
- Highlights the diagnostic challenges in pediatric periorbital swelling.
- Emphasizes the importance of advanced imaging (CT/MR) for accurate diagnosis and treatment planning.
- Demonstrates effective antibiotic and surgical management with no reported sequelae.
Abstract:
During a six-year period 28 febrile children with acute periorbital swelling were identified. Median age was 1.8 years (range, two weeks-nine years). When possible, the children were classified as having preseptal cellulitis (infectious focus in the subcutaneous tissue in front of the orbital septum) or postseptal cellulitis (focus in the paranasal sinuses). In six children a diagnosis of preseptal subcutaneous cellulitis was based upon the clinical presentation and positive culture results. Five children were additionally classified as having preseptal cellulitis due to severe conjunctivitis. Fifteen children were classified as having postseptal cellulitis due to infection in the paranasal sinuses (ethmoiditis). In seven of the latter cases the diagnosis was based upon the results of CT/MR-scans or operation. Two children could not be classified. All children were given antibiotic treatment and four had an operation. There were no recurrences or sequelae. In our study a presumed diagnosis could be made in retrospect in most cases, but at the time of presentation the clinical picture was often confusing. We found a CT- or MR-scan to be most helpful, especially in identifying the children requiring surgical treatment.