Periorbital Infections Research Articles

Role of Acute Rhinosinusitis in Periorbital Infections in Children

ObjectivePeriorbital cellulitis in children are commonly caused by acute rhinosinusitis (ARS). This study investigated the association of ARS and the severity of periorbital cellulitis in children. Study designRetrospective case-control study of children with periorbital cellulitis with ARS versus periorbital cellulitis without ARS. SettingPatients were seen at West Virginia University Children's Hospitals between August 2011 to August 2022. MethodsPatients were divided into cases and controls based on presence or absence of ARS. ARS was defined based on clinical symptoms with objective presence of disease on CT scan. Patients’ characteristics, treatment, hospital length of stay, and readmission were collected. ResultsThe sample consisted of 118 pediatric patients with orbital cellulitis. Patients with ARS were younger than patients without ARS (6.3 vs 8.5, p = 0.025), however there were no sex differences between two groups (p = 0.540). The ARS group had higher incidence of postseptal cellulitis (51.5% vs 9.6%, p < 0.001). As compared to patients without ARS, patients with ARS were more likely to be admitted (p < 0.001), have a longer length of stay (median of 3.5 days vs 0.5 days, p < 0.001), require IV antibiotics (95.3% vs 54.9%, p < 0.001), and require surgical intervention (23.1% vs 5.8%, p < 0.001). Readmission rate was similar between the two groups. ConclusionChildren presenting with acute periorbital cellulitis who have ARS tend to have more severe infection requiring higher level of care. ARS should be assessed and incorporated into the plan of care of pediatric patients with periorbital infections.

46 Association of Empiric Antibiotic Selection on Clinical Outcomes in Hospitalized Children with Severe Orbital Infections: A Multicenter Cohort Study

Abstract Background Antibiotic selection in children with periorbital and orbital infections is often empiric and regimens vary widely among institutions in their spectrum and inclusion of anti-anaerobic and anti-staphylococcal agents. Objectives Currently, there are no national clinical guidelines for antibiotic selection and no studies comparing commonly used antibiotic regimens in orbital infections. We aimed to determine the association of initial empiric antibiotic regimens with clinical outcomes in children hospitalized with severe orbital infections. Design/Methods We conducted a multicentre cohort study of children with severe orbital infections admitted to ten hospitals between January 1, 2009, and December 31, 2018. The association between empiric antibiotic regimen in the first 24 hours of hospitalization with length of stay and surgical intervention were assessed with multivariable median regression and multivariate logistic regression, respectively. Results Of 1421 patients, 60.0% were male, and mean age was 6.4 years (SD 4.5). Median length of stay was 86.4 hours (IQR 56.9-137.5) and 180 (12.7%) received surgical intervention. The most frequently (23.6%) administered empiric regimen consisted of a third-generation cephalosporin, anaerobic agent, and staphylococcal agent. After adjustment, broad-spectrum empiric antibiotic regimens with dedicated anti-anaerobic and/or staphylococcal coverage were associated with increased length of stay, ranging from an additional 18.4 hours (95% CI, 6.82, 30.0) to 21.5 hours (95% CI, 11.0, 32.0). Only patients with staphylococcal coverage alone had a statistically significant increased odds of surgical intervention (4.45, 95% CI 1.03, 19.2). Conclusion In children hospitalized with severe orbital infections, broad-spectrum therapy with or without coverage for staphylococci and anaerobes were associated with similar clinical outcomes in a clinical setting with low methicillin-resistant Staphylococcus aureus prevalence. Clinical practice guidelines are needed to standardize antibiotic recommendations.

124 Utility of Point-of-Care Ocular Ultrasound in the Evaluation of Periorbital and Orbital Infections

Periorbital and orbital infections are one of the frequent reasons for emergency department (ED) visits. Emergency Physician-performed point-of-care ultrasound (POCUS) has become more prevalent in the evaluation of patients presenting to the emergency department (ED). The objective of this study is to determine the utility of POC ocular ultrasound in the assessment of patients presenting to the ED with suspected preseptal and septal (orbital) cellulitis.

Orbital abscess: 20 years’ experience at a tertiary eye care center

ABSTRACT Purpose To study the clinical, microbiological profile and management outcomes of orbital abscess at a tertiary care center in South India. Material and Method In a retrospective interventional case series, we reviewed all patients diagnosed with orbital cellulitis from 2000–2020. The data analyzed included demographic profile, clinical and radiological features, microbiological profile, and management outcome. Results A total of 921 cases of orbital and periorbital infections were reviewed. Seventy-two cases were diagnosed as orbital cellulitis. Thirty-four cases (47.22%) had radiological evidence of orbital abscess. The median age was 20.63 years. Three patients (8.82%) were neonates. A male preponderance was noted (23, 67.65%). Sinusitis (10, 29.41%) and diabetes (5, 14.7%), were the most common predisposing factors. Optic neuropathy was seen in 15 (44.11%) patients, cavernous sinus thrombosis in two patients (5.88%), and septicemia in one patient (2.94%) Multiple orbital abscesses were noted in 7 (20.59%) cases. All patients underwent surgical drainage. Methicillin-sensitive Staphylococcus aureus was the most common organism isolated in 14 patients (41.18%). Vision improvement or stabilization was seen in all except 3 (8.82%) Conclusion Orbital abscess is a potential sight-threatening orbital infection. The infective process can spread and ascend up to involve cavernous sinus thereby becoming life-threatening. A timely diagnosis and intervention can halt the disease process and help restore vision in many cases.

Orbital Abscess—Two Case Reports with Review

Periorbital infections lead to severe condition of the orbital abscess, and eventually to sight loss, and even death. Current study aims in reviewing the literature regarding orbital abscess in adult patients and presenting 2 original cases. A surgical intervention to drain the abscess and a revision of the orbital was required. A review of literature is also reported focusing on aetiology and treatment options dealing with an orbital abscess.

Paediatric periorbital cellulitis: A 10-year retrospective case series review.

To identify the predictors of poor outcome and need for surgical management in paediatric patients with periorbital cellulitis. To assess the adherence to local guidelines in the management of periorbital cellulitis. Retrospective descriptive analysis of clinical, laboratory and radiological characteristics of 175 paediatric periorbital cellulitis presentations at a UK teaching hospital over a 10-year period. Regression investigated correlations for continuous and categorical variables. A total of 175 paediatric presentations were diagnosed as periorbital infections over the 10-year period. Of these, 139 had pre-septal cellulitis, 27 had a subperiosteal abscess, 6 had an orbital cellulitis, 1 had an orbital abscess, 1 a cavernous sinus thrombosis and 1 an extradural abscess. Median age at presentation was 5 years (range: 1 month-17 years). In total, 169 (97%) cases received systemic antimicrobial treatment. Cross-sectional imaging occurred in 30% of cases and 18% required surgical intervention. Increasing C-reactive protein was associated with greater risk of post-septal disease and requiring surgery. The best predictors of post-septal disease in the multivariate analysis (R2 = 0.49, P = ≤0.001) were ophthalmoplegia (P = 0.009), proptosis (P = 0.016) and pain on eye movement (P = 0.046). Proptosis was the single most significant predictor of surgical management (R2 = 0.53, P = <0.001). Multidisciplinary involvement and early medical management can improve outcomes for most patients. Those who deteriorate despite medical management should be considered for prompt imaging and surgical management to avoid serious life-threatening or sight-threatening complications.

Paediatric orbital and periorbital infections

This study is a review of recent literature in the diagnosis and management of preseptal cellulitis, orbital cellulitis and dacryocystitis, including causative organisms, diagnosis and medical or surgical therapy and potential complications. Advances in vaccination against Haemophilus influenzae B have resulted in a shift in the most common causative organisms of preseptal and orbital cellulitis. Management of orbital cellulitis has been advanced by adjuvant corticosteroids, and subperiosteal abscess volumes of more than 1250 ml has been shown as predictive for requiring potential surgical intervention. Periorbital infections require prompt evaluation and management. Although the infectious organisms in both preseptal and orbital cellulitis include Staphylococcus/Streptococcus species, management may differ significantly on the basis of the nidus of infection, presenting signs and symptoms, and response to initial medical management.

Pediatric intraorbital abscess: Early recognition and management.

Key Clinical MessageOrbital involvement occurs in 85% of complicated acute sinusitis and is more prevalent in children. Prompt differentiation between the more common periorbital (preseptal) cellulitis and infections, posterior to the orbital septum (including orbital cellulitis/abscess), is essential due to the latter's risk of irreversible optic neuropathy, intracranial spread and death.

Periorbital infections and conjunctivitis due to Panton-Valentine Leukocidin (PVL) positive Staphylococcus aureus in children

BackgroundColonisation with Panton-Valentine Leukocidin expressing strains of Staphylococcus aureus (PVL + SA) is characterised by recurrent skin and soft tissue infections. While periorbital and orbital infections are common in children and frequently caused by S. aureus the role of PVL + SA in recurrent eye infections has not been studied.This study aimed to detect and report frequency and recurrence of periorbital or orbital infections as additional symptoms of PVL + SA colonisation in children.MethodsWe conducted a retrospective cohort study of pediatric patients who were treated for PVL + SA skin and soft tissue infection in our in- and outpatient clinics in Berlin, Germany from January 2012 to January 2017. We identified cases with periorbital or orbital infections in the year prior to the first PVL + SA evidence. In these cases, we conducted follow-up interviews by phone to determine recurrence of symptoms after the completion of decolonisation procedures.ResultsFifty pediatric patients (age range: one week to 17 years) were evaluated and treated for PVL + SA infections in the reported time period. 19 patients (38%) reported periorbital infection or conjunctivitis, with recurrent hordeola as the most frequent finding (n = 9; 18%). Reappearance of hordeola (n = 5) was associated with recurrence of skin and soft tissue infections and/or de novo detection of PVL + SA. No further hordeola or other eye infections occurred after successful decolonisation.ConclusionOur findings suggest a frequent involvement of periorbital skin in children with PVL + SA infections. Pediatric patients with recurrent periorbital infections might benefit from PVL + SA screening and consecutive decolonisation procedures.

English

INTRODUCTION: Orbit is a sterile closed compartment surrounded by bony walls on all sides and anteriorly by orbital septum. The orbit houses the eyeball and has the major function of protection of eyeball and helps in its motility in extreme degrees. Orbit has many potential spaces that make it a primary site of infections. It may present either as a secondary site for infections from the adjacent structures or intermediary site for infection to other vital sites. Orbital anatomy and its relation with other adjacent structures are important in the pathogenesis of orbital infections. These relationships also explain its devastating consequences and influence therapeutic decisions. Orbital and periorbital infections may be caused by variety bacterial, fungal and parasitic agents. Appropriate management depends on appreciation of topography of the process within the orbit and periorbital tissues using Radioimaging and identification of responsible organisms and its sensitivity to antibiotics using Microbiological study. Appropriate management by either medical or surgical treatment helps in prevention of complications.1e Integration of history, physical and ocular examination and ancillary testing allow achievement of these primary goals. AIM OF THE STUDY: To evaluate orbital infections and analyse the role of Radioimaging and Microbiological study in early diagnosis, management and outcome. OBJECTIVES: To analyse the prevalence, etiopathogenesis and various clinical presentations of orbital infections and role of Radioimaging and Microbiological study in its early diagnosis, treatment and outcome. METHODS OF EVALUATION: This prospective study was conducted at Orbit and Oculoplasty department, RIOGOH, Egmore, Chennai for a period of 12 months during when 30 patients with Orbital infections were evaluated RESULTS: Out of 30 patients, 16 patients (53.4%) were diagnosed to have Preseptal cellulitis, 8 patients (26.7%) and 4 patients (13.3%) were diagnosed with Orbital cellulitis and Orbital abscess respectively. Rest of the 2 patients were diagnosed with Subperiosteal abscess and Cavernous sinus thrombosis. Radiological and Microbiological investigations were done in patients according to their needs Out of the 20 medically treated with appropriate antibiotics, all patients improved. Out of the 10 surgically treated, 2 patients (20%) deteriorated. CONCLUSION: Orbital infections are more common in paediatric age group and preseptal cellulitis is the commonest infection encountered. Periocular infections are the most common causative factor for the orbital infections. Bacteria is the major causative organism for orbital infections. Among it, gram positive organisms predominate the cause. Fungi constituted the second major cause. Radioimaging like X Ray, B scan, CT Scan and MRI help in diagnosis, identification of complications and in assessment of response of treatment in orbital infections. They are complimentary to one another. Microbiological study with Gram Staining, Culture and Sensitivity and Fungal culture help in the identification of Strain of Organism and in Correct choice of antibiotics that is important in the complete cure of infections. Most of the orbital infections resolve with the prompt treatment. Surgical approach forms the treatment of choice in abscess and it should be followed by medical treatment according to the microbiological study. Radioimaging and Microbiological study play a significant role in the choice of treatment. Radioimaging is used to assess, response to treatment and to modify treatment for a better outcome.

A child with rapidly progressive necrotizing group a streptococcal Tenon's capsule infection one day after strabismus surgery

Periorbital infections after strabismus surgery are rare. We describe the first reported case of necrotizing group A streptococcal infection of the conjunctiva and Tenon's capsule complicating uneventful strabismus surgery in a 23-month-old boy, successfully managed with conservative intraoperative debridement and with targeted local and systemic antibiotics.

Radiographic Findings and Clinical Correlates in Pediatric Periorbital Infections.

To review radiographic studies of pediatric patients presenting with periorbital infections and to evaluate sinonasal anatomical factors and clinical course related to this disease process. Retrospective study review of computed tomography (CT) scans in 100 patients less than 18 years old, admitted to a tertiary children's hospital with the diagnosis of an orbital infection. CT scans were reviewed for anatomic variants and Lund-Mackay scores were calculated. An independent chart reviews of the treatment course and need for surgical intervention was performed. Of 100 patients, 67% were male, 60% had left-sided infections, and 30% of patients were treated with surgical drainage. Adenoid hypertrophy (61%), inferior turbinate hypertrophy (80%) and septal deviation (47%) were common, but did not show statistical correlation with the need for surgical intervention. Dehiscence of the lamina papyracea was identified in 21% of patients treated without surgery and in 76% of those requiring surgery (P 0.0048). The average overall Lund-Mackay score was 11.8 and did not correlate with the need for surgical intervention. To our knowledge, this is the first study to evaluate the incidence of sinonasal anatomic abnormalities in children presenting with periorbital infections. This study also demonstrated that lamina papyracea dehiscence is a common finding and is associated with higher rates of surgical intervention. Such findings may have an important role in the diagnosis, surveillance and management of sinus disease in the pediatric population.

Local Allergic Reaction to Ocular Chloramphenicol Ointment: A Diagnosis by High Index of Clinical Suspicion

Chloramphenicol is a widely used topical ointment applied routinely for ocular and periorbital infections due to its wide spectrum of anti-bacterial activity. Local delayed hypersensitivity reaction to chloramphenicol is a well reported but uncommon adverse effect, and has been reported to mismanaged initially as an infective cellulitis. The confirmatory tests for drug allergy are often not possible in developing countries and hence, the diagnosis is usually made with high index of clinical suspicion. Hereby, we are reporting a case of local hypersensitivity reaction to chloramphenicol after ocular use for adenexal infection, which was diagnosed with high index of suspicion without any diagnostic test, and was managed timely and successfully.

Periorbital infections after Dermabond closure of traumatic lacerations in three children

To report the occurrence of periorbital infections in 3 children treated with the tissue adhesive 2-octyl cyanoacrylate (Dermabond) after traumatic periorbital laceration. We retrospectively reviewed the records of consecutive patients referred to Vanderbilt Children's Hospital for the treatment of periorbital infections to identify cases associated with the use of Dermabond. The clinical features and outcomes of each case were reviewed. We performed a meta-analysis of published cases to identify any association of tissue adhesive with wound infection rate. The review identified 3 patients, all of whom were younger than 3 years of age and developed cellulitis within 24 hours of wound closure. Broad-spectrum intravenous antibiotic therapy was started in less than 3 hours in all cases. Cultures were obtained in 2 of the 3 cases; both grew Streptococcus pyogenes. Two cases required surgical intervention, including one with necrotizing fasciitis. In the meta-analysis, the wound infection rate was 1.8% in tissue adhesive closure and 0.3% in standard wound closure (odds ratio 6.0; 95% confidence interval 0.7-50.3, P = 0.06). The development of periorbital cellulitis after the closure of periorbital lacerations with Dermabond should alert the physician to the possibility of periorbital infection, including necrotizing fasciitis. The literature review suggests a trend toward an increased infection rate with tissue adhesive closure. We propose that ineffective wound sterilization before tissue adhesive wound closure may be a contributing factor.

Orbital and Periorbital InfectionsOrbital and Periorbital Infections

Objectives: To describe the epidemiologic features of pediatric orbital and periorbital infections from a national perspective and to identify predictors of surgery. Design: Analysis of the Kids' Inpatient Database. Setting: Administrative data set. Patients: Pediatric inpatient admissions with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of orbital cellulitis. Main Outcome Measures: Hospital admission, socioeconomic, and clinical variables were examined and predictors of surgical intervention were evaluated using logistic regression. Results: A total 5440 hospital admissions was noted for pediatric orbital cellulitis; of these, 672 patients (12.4%) underwent surgical intervention. Mean length of stay for all patients was 3.8 days; 90.4% were routinely discharged. Patients who had surgery were older, with a mean (SE) age of 10.1 (0.29) years compared with 6.1 (0.10) years for nonsurgical patients (P Conclusions: This study describes the medical and surgical management of pediatric orbital and periorbital infections from a national perspective. Predictors of surgical intervention include older age, presentation with diplopia, and hospital admission via the emergency department. Knowledge of these variables facilitates analysis of resource utilization for pediatric orbital cellulitis and can be used to optimally triage patients, ultimately reducing costs and lengths of stay while preserving quality of care.

Orbital and Periorbital Infections&lt;subtitle&gt;A National Perspective&lt;/subtitle&gt;

To describe the epidemiologic features of pediatric orbital and periorbital infections from a national perspective and to identify predictors of surgery. Analysis of the Kids' Inpatient Database. Administrative data set. Pediatric inpatient admissions with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of orbital cellulitis. Hospital admission, socioeconomic, and clinical variables were examined and predictors of surgical intervention were evaluated using logistic regression. A total 5440 hospital admissions was noted for pediatric orbital cellulitis; of these, 672 patients (12.4%) underwent surgical intervention. Mean length of stay for all patients was 3.8 days; 90.4% were routinely discharged. Patients who had surgery were older, with a mean (SE) age of 10.1 (0.29) years compared with 6.1 (0.10) years for nonsurgical patients (P<.001). Surgical patients had a significantly longer mean hospital stay (7.1 vs 3.4 days, P<.001) and a higher mean cost of care ($41009 vs $13008, P<.001) compared with nonsurgical patients. Demographic predictors of surgical intervention included male sex, admitting characteristics, and hospital location. Except for sex, these variables remained significant in a multivariate model. Clinically, diplopia is a predictor of surgical intervention (odds ratio, 6.3; 95% confidence interval, 3.4-11.7). This study describes the medical and surgical management of pediatric orbital and periorbital infections from a national perspective. Predictors of surgical intervention include older age, presentation with diplopia, and hospital admission via the emergency department. Knowledge of these variables facilitates analysis of resource utilization for pediatric orbital cellulitis and can be used to optimally triage patients, ultimately reducing costs and lengths of stay while preserving quality of care.

Pediatric Periorbital Infections: 5‐Year Retrospective Study

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 &lt; .001) and history of trauma or skin infection ( P &lt; .001). Proptosis ( P &lt; .001), diplopia ( P &lt; .01) and ophthalmoplegia ( P &lt; .001) were more frequent in post-septal infections and surgical intervention was exclusive of this group. Subperiosteal abscess patients were significantly older ( P &lt; .05), and all of them had diagnosis of acute sinusitis ( P &lt; .05). Proptosis ( P &lt; .05), ophtalmoplegia ( P &lt; .05) and diplopia ( P &lt; .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.

Acute Rhinosinusitis—Related Orbital Infection in Pediatric Patients: A Retrospective Analysis

Periorbital infection frequently originates from acute rhinosinusitis in children. We tried to find the characteristics of pediatric patients who are likely to develop subperiosteal orbital abscesses and to need emergency surgery for acute orbital swelling. In an observational retrospective cohort study, we reviewed 64 children less than 18 years of age who visited emergency rooms for periorbital swelling and were hospitalized with a diagnosis of periorbital cellulitis and subperiosteal orbital abscess between 1996 and 2007 at Chang Gung Memorial Hospital. The presence of periorbital abscess was diagnosed radiographically, and all of the patients had concomitant sinusitis that was proved by computed tomographic scan. The mean age of the patients was 6.95 years, and 42 (65.63%) were male (male-to-female ratio, 1.91). Thirty patients (46.88%) had surgical drainage, and 34 (53.13%) received antibiotic therapy only. The factors associated on bivariate analysis with abscess formation were age of 6 years or less (p = 0.023), proptosis (p = 0.012), fever (p < 0.001), and a white blood cell count of more than 11,100 cells per microliter (p = 0.004). On multivariate analysis, fever and proptosis were independent factors that predicted abscess formation. In patients who underwent surgical drainage, the most frequently cultured microbes were Staphylococcus aureus, Streptococcus viridans, and coagulase-negative staphylococci, and 29% of our patients had polymicrobial pus cultures. The most important factor in predicting the failure of antibiotic treatment of sinusitis-related periorbital infections is abscess formation. Patients with fever and proptosis are prone to develop subperiosteal orbital abscesses.

Acute Periorbital Infections: Who Needs Emergent Imaging?

Acute Periorbital Infections: Who Needs Emergent Imaging?

Acute Periorbital Infections: Who Needs Emergent Imaging?

Computed tomography (CT) is used often in the evaluation of orbital infections to identify children who are most likely to benefit from surgical intervention. Our objective was to identify predictors for intraorbital or intracranial abscess among children who present with signs or symptoms of periorbital infection. These predictors could be used to better target patients for emergent CT. This was a retrospective cohort study of all patients admitted to an urban pediatric tertiary care emergency department between 1995 and 2008. We included otherwise healthy patients with suspected acute clinical periorbital or orbital cellulitis without a history of craniofacial surgery, trauma, or external source of infection. Immunocompromised patients and patients with noninfectious causes of periorbital swelling were excluded. Variables analyzed included age, duration of symptoms, highest recorded temperature, previous antibiotic therapy, physical examination findings, laboratory results, and interpretation of imaging. CT scans of the orbit were reread by a neuroradiologist. Nine hundred eighteen patients were included; 298 underwent a CT scan, and of those, 111 were shown to have an abscess. Although proptosis, pain with external ocular movement, and ophthalmoplegia were associated with presence of an abscess, 56 (50.5%) patients with abscess did not experience these symptoms. Other variables associated with the presence of an abscess in multivariate analysis were a peripheral blood neutrophil count greater than 10,000/microL, absence of infectious conjunctivitis, periorbital edema, age greater than 3 years, and previous antibiotic therapy (P < .05 for all). Our recursive partitioning model identified all high-risk (44%) patients as well as a low-risk (0.4%-2%) group (Rsq = 0.27). We confirmed that patients with proptosis and/or pain or limitation of extraocular movements are at high risk for intraorbital abscess, yet many do not have these predictors. Other features can identify patients who do not have such obvious predictors but do have significant risk of disease. A recursive partitioning model is presented.