Pediatric Periorbital Infections: 5‐Year Retrospective Study

Abstract

Objective: Periorbital infections in the pediatric population are a common situation in hospital emergency care that can lead to visual loss, intracranial infection, or even death. We evaluated presentations and outcomes of pediatric periorbital cellulitis in order to understand different etiologies and stratifying risk populations that need different diagnostic and treatment approaches. Method: We retrospectively reviewed the pediatric patients admitted at our institution with the diagnosis of periorbital cellulitis over a period of 5 years. They were classified in subgroups according to Chandler and cross-referenced in demographics, clinical features, co-morbidities, days of in-hospital staying, CT findings, and treatment modalities. Results: We identified 112 children with periorbital cellulitis, 63 pre-septal and 49 post-septal. There were statistically significant differences between the two groups in regard to age ( P < .001) and history of trauma or skin infection ( P < .001). Proptosis ( P < .001), diplopia ( P < .01) and ophthalmoplegia ( P < .001) were more frequent in post-septal infections and surgical intervention was exclusive of this group. Subperiosteal abscess patients were significantly older ( P < .05), and all of them had diagnosis of acute sinusitis ( P < .05). Proptosis ( P < .05), ophtalmoplegia ( P < .05) and diplopia ( P < .05) were also differentiating features of subperiosteal abscess. Conclusion: Pre-septal infections are more common in younger children. Older children with subperiosteal abscesses need surgical intervention more often. Proptosis, diplopia, and opfthamoplegia are significant identifying features of post-septal infections, particularly in surgical patients. Trauma or skin infections are relevant findings of pre-septal infections. Post-septal infections are mostly a complication of acute sinusitis.