A decade of experience managing orbital and periorbital cellulitis in children in the post-Hib vaccination era

Abstract

<h3>Introduction</h3> Infections of the soft tissues around the eye, with redness and swelling, cause significant morbidity and have the potential to develop serious complications. Periorbital cellulitis, where the position and function of the eye is unaffected, is the result of preseptal soft tissue infection, and occurs more frequently than orbital cellulitis. Orbital cellulitis, with proptosis, painful eye movements and occasionally visual loss is a less common, though potentially much more serious condition. Early recognition, prompt management and appropriate referral are crucial. <h3>Objectives</h3> Routine immunisation against Hib was introduced in the UK in 1992. The incidence and epidemiology of pre and postseptal cellulitis in the post Hib vaccination era has not been studied extensively. We reviewed the clinical features, management, complications and follow up of patients with orbital and periorbital cellulitis in the post-immunisation era. <h3>Methods</h3> We retrospectively reviewed medical notes of 50 children with orbital and periorbital cellulitis admitted to our paediatric department between 2000 and 2010. We looked at age, gender, month of admission, number of days of illness before admission, clinical features, inflammatory response including temperature, WCC, CRP on/during admission, immunisation status, blood culture results, microbiology studies, radiology findings, antibiotics, complications, duration of hospital stay and follow up. <h3>Results</h3> 45 (90%) patients had periorbital cellulitis and 5 (10%) had orbital cellulitis. 9 (18%) were aged less than 1 year and 27 (54%) were aged 1-7. 27 (54%) were female. 23 (46%) admissions were between December and February. 22 (44%) had ENT symptoms. 40 (80%) patients were apyrexial, 13 (26%) had a CRP &gt;60 mg/L and 5 had a WCC of &gt;20×106/L. 43 (86%) had blood cultures, with one positive growth of Micrococcus. Eye swabs were performed in 12 patients and 3 had a positive growth of Staphylococcus aureus. Most of the patients were seen by ophthalmologists and had radiology studies; all received antibiotics. Surgery was required for six patients. We had the immunisation record for 36 patients and only 2 of those were not fully immunised. <h3>Conclusions</h3> In the post Hib-vaccination era bacteraemia and sepsis are now rarely seen in acute orbital/periorbital infections. Upper respiratory tract infection and conjunctivitis remain important predisposing factors. Significant complications can still occur when periorbital cellulitis is present.