Presentation and management of pediatric orbital cellulitis.

Fall 2011

Fanella S, Singer A, Embree J.

Source

Section of Infectious Disease, Department of Pediatrics

Abstract

BACKGROUND:

Orbital cellulitis is a serious, vision-threatening infection.

OBJECTIVE:

To review the epidemiology and clinical data of pediatric orbital cellulitis in Manitoba.

METHODS:

A 12-year retrospective review was conducted of all children (younger than 18 years of age) with orbital cellulitisadmitted to Manitoba's only tertiary pediatric centre. Admission rates for orbital cellulitis were compared over three distinct time periods, based on licensure and funding levels of the heptavalent pneumococcal conjugate vaccine (PCV7) in Manitoba.

RESULTS:

Thirty-eight patients with orbital cellulitis were identified. Of these, 11% were of Aboriginal ethnicity in contrast with 30% to 40% of children who were admitted for other respiratory illnesses. Subperiosteal abscesses occurred in 31.5%. Only eight patients (21%) required surgery. Follow-up imaging after presentation usually did not indicate a need for subsequent surgical drainage. 

The mean number of orbital cellulitis cases per 1000 admissions for the following periods - before PCV7 licensure, after licensure and before full provincial funding, and after licensure and full funding - were 0.39, 0.53 and 0.90, respectively. No significant difference was noted among any of the periods as PCV7 coverage increased.

CONCLUSIONS:

The rate of subperiosteal abscesses was lower than other reports. This may be due to the median age at presentation. In contrast to admissions for most other respiratory infections at the Winnipeg Children's Hospital (Winnipeg, Manitoba), Aboriginal ethnicity was uncommon. Surprisingly, rates of admissions for orbital cellulitis appeared to show an increasing trend with increasing access to PCV7 in Manitoba, although overall the number of cases was very small. Studies into the changing microbiology of orbital cellulitis and sinusitis are warranted.

PubMed

Orbital cellulitis.

Jan 2012

[Article in French]

Mouriaux F, Rysanek B, Babin E, Cattoir V.

Source

Service d'ophtalmologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.

Abstract

Orbital cellulitis is uncommon in ophthalmologic practice. The majority of cases arise from direct spread of sinus infection or eyelid infection. Clinically, orbital cellulitis is divided into two forms: the preseptal form, anterior to the orbital septum, and the retroseptal form, posterior to the orbital septum. Management and prognosis differ widely between the two types. The retroseptal form or "true" orbital cellulitis is a severe disease with potentially disastrous consequences for vision and survival. Clinical examination and urgent CT scanning are indispensable for correct diagnosis, evaluation of severity, surgical planning and antibiotic selection.

EM/Consulte

Microbiology of Pediatric Orbital Cellulitis.

Microbiology of Pediatric Orbital Cellulitis.
Am J Ophthalmol. 2007 Aug

McKinley SH, Yen MT, Miller AM, Yen KG.
Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.

PURPOSE: To evaluate the microbiology of pediatric orbital cellulitis associated with sinusitis.

DESIGN: Retrospective review of medical records of pediatric patients treated for orbital cellulitis.

METHODS: All pediatric patients treated for orbital cellulitis associated with sinusitis at Texas Children's Hospital between December 1, 2001 and September 30, 2005 were reviewed. Data collected included patient age, history, microbiology results, and surgical intervention.

RESULTS: Thirty-eight cases were identified. Fifteen cases required medical management, whereas 23 patients received a combination of medical and surgical intervention. Three patients had multiple surgical procedures performed. Of the procedures performed, four were sinus irrigation, 12 were sinusotomy and drainage, nine were orbitotomy with drainage of abscess, and one was craniotomy with drainage of abscess. Surgical aspirate specimens yielded a higher positive culture result rate with 9/9 of orbital abscesses and 13/16 of sinus aspirates demonstrating a positive yield. Two of the 27 blood cultures had a positive yield. Staphylococcus species was the most common organism isolated. Methicillin-resistant S. aureus (MRSA) represented 73% of S. aureus isolates. Streptococcus species was the next most common pathogen. Three cultures yielded Haemophilus species with one being positive for H. influenzae.

CONCLUSIONS: Organisms responsible for causing pediatric orbital cellulitis are evolving, with Staphylococcus followed by Streptococcus species being the most common pathogens. The occurrence of MRSA in pediatric orbital cellulitis is increasing, and empiric antimicrobial therapy should be directed against these organisms if they are prevalent in the community. Sinus and orbital abscess aspirates yielded the greatest number of positive cultures, though these invasive surgical procedures should be performed only when clinically indicated.

Microbiology of Pediatric Orbital Cellulitis.

Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East.

Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East.
Ophthalmology. 2007 Feb;114

Chaudhry IA,
Shamsi FA,
Elzaridi E,
Al-Rashed W,
Al-Amri A,
Al-Anezi F,
Arat YO,
Holck DE.

Oculoplastic and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. orbitdr@hotmail.com

PURPOSE: To describe risk factors predisposing patients to orbital cellulitis and potential complications in patients treated at a tertiary eye care referral center in the Middle East.

DESIGN: Noncomparative, interventional, retrospective case series.

PARTICIPANTS: Patients diagnosed with orbital cellulitis.

METHODS: A 15-year clinical review of patients with a diagnosis of orbital cellulitis referred to King Khaled Eye Specialist Hospital, an accredited (Joint Council on Accreditation of Healthcare Organizations, Washington, DC) tertiary care center in Riyadh, Saudi Arabia, was performed. Only those patients who had clinical signs and symptoms or radiologic evidence suggestive of orbital cellulitis were included in the study.

MAIN OUTCOME MEASURES: Patient demographics, factors predisposing to orbital cellulitis, and resulting complications.

RESULTS: A total of 218 patients (136 male, 82 female) fulfilling the diagnostic criteria for orbital cellulitis were identified. The average age of these patients was 25.7 years (range, 1 month-85 years). On imaging studies, there was evidence of inflammatory or infective changes to orbital structures; orbital abscesses were identified in 116 patients (53%). Sinus disease was the most common predisposing cause in 86 patients (39.4%), followed by trauma in 43 patients (19.7%). All patients received systemic antibiotic treatment before the identification of any responsible organisms. Of the 116 patients with orbital abscess, 101 patients (87%) required drainage. The results of cultures in patients in whom an orbital abscess was drained were positive for 91 patients (90%). The most common microorganisms isolated from the drained abscesses were Staphylococci and Streptococci species. Blood cultures were positive in only 4 patients from whom blood was drawn for cultures. Visual acuity improved in 34 eyes (16.1%) and worsened in 13 eyes (6.2%), including 9 (4.3%) eyes that sustained complete loss of vision, which was attributed to the delay in correct diagnosis and timely intervention (average 28 days vs. 9 days in patients with no loss of vision.

CONCLUSIONS: Untreated sinusitis and prior history of orbital trauma were the 2 major causes of orbital cellulitis in patients referred to a tertiary care eye center in the Middle East. Although rare, severe visual loss still remains a serious complication of delayed detection and intervention in most cases of orbital cellulitis.

PMID: 17270683 [PubMed - in process]