[Orbital cellulitis in children].

BACKGROUND

Because the potential for complications is great, orbital cellulitis must be recognized promptly and treated aggressively.

METHODS

The files of 38 children admitted from 1988 to 1993 because of orbital or periorbital cellulitis were retrospectively analyzed. Clinical findings included fever, edema, pain, rhinorrhea, conjunctivitis, limitation of eye movement, loss of vision and ophthalmoplegia. All patients had hemogram, ionogram, blood cultures, search for soluble antigens in blood and/or urine, C-reactive protein measurement; they also had roentgenographic examination of the sinuses, orbital ultrasonography and/or CT scan in patients with retroseptal cellulitis. All patients were given systemic antibiotic therapy.

RESULTS

Thirty-five patients had preseptal and three retroseptal cellulitis. Preseptal cellulitis was associated to sinusitis in 17 patients, to ocular infection in 11 (seven conjunctivitis and four dacryocystitis), to an infected wound in six. Seventy-three per cent of the patients with ocular infection were less than 2 years of age with a significant preponderance of girls (64%). The three cases of retroseptal cellulitis were associated to sinusitis. Orbital echography was performed in five cases, permitting to recognize the three cases of retroseptal cellulitis that was confirmed by CT scan. Twenty-five of the 38 children were given oral antibiotics during the days preceding admission, explaining the relative rarity of positive bacteriological findings (seven cases). Thirty-five of the 38 children were given IV cefotaxime + fosfomycin, associated to netromycin in 16 cases. Mean duration of treatment was 3 days (range: 1-7). IV antibiotherapy was followed by oral amoxicillin-clavulanic acid administration in 25 patients and pristinamycin in 11.

CONCLUSIONS

Orbital cellulitis in children, more frequently preseptal, have a good prognosis under adapted antibiotherapy. A retroseptal cellulitis requires multidisciplinary management because of the risk of extension of infection from the orbit to the eye and/or into the cranial cavity.