688 PERIORBITAL AND ORBITAL CELLULITIS-A REAPPRAISAL

Abstract

Important differences between periorbital cellulitis (PC),orbital cellulitis or abscess (OC), and periorbital swelling (PS) associated with sinusitis have been obscured because these terms are often used interchangeably. All cases of PC and OC with a positive blood,tissue aspirate,or abscess culture seen at Children's or Eye and Ear Hospital in the past 10 years were analyzed. Results (including median age):PC caused by HIB and SP, characterized by bacteremia, fever and periorbital swelling, discoloration, induration and pain, is a distinct clinical entity occurring in young children;sinus radiographs frequently demonstrated “cloudy” sinuses,but interpretation of the radiographs was complicated by the small size and indistinct bony margins of the sinuses of infants, and by concurrent upper respiratory infection and overlying soft tissue swelling. Ophthalmoplegia and proptosis, never present in cases of PC, always accompanied OC as did radiographic evidence of sinusitis. OC due to HIB has not been documented in this study or in the literature. PS secondary to sinusitis is characterized by non-tender, non-indurated edema due to venous congestion, not bacterial cellulitis. Careful differentiation of PC,OC and PS secondary to sinusitis is necessary for the selection of appropriate therapy.