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Volume 40, Number 6, December 2007

Clinical analysis of computed tomography-staged orbital cellulitis in children


Chen-Fang Ho, Yhu-Chering Huang, Chao-Jen Wang, Cheng-Hsun Chiu, Tzou-Yien Lin
Division of Infectious Diseases, Department of Pediatrics, Chang Gung Children’s Hospital and College of Medicine, Chang Gung University, Taoyuan; and 2Department of Radiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

Received: May 29, 2006    Revised: July 26, 2006    Accepted: August 22, 2006   

 

Corresponding author:

Dr. Yhu-Chering Huang, Department of Pediatrics, Chang Gung Children’s Hospital, No. 5-7, Fu-Hsin St, Kweishan, Taoyuan 333, Taiwan. E-mail: Dr. Yhu-Chering Huang This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Background and purpose: 

Bacterial infection of the orbital structures can affect all age groups, but is more frequent in pediatric populations. Prompt recognition, correct diagnosis, and adequate management are important if serious complications are to be avoided. This study sought to delineate the clinical, bacteriological and radiological findings, management and outcome of orbital cellulitis.

 



 

Methods:

This retrospective study reviewed 80 children admitted to Chang Gung Children’s Hospital with a diagnosis of orbital cellulitis who were staged by computed tomography (CT), between January 1999 and August 2005. The staging classification was as follows: stage I, inflammatory edema (preseptal); stage II, subperiosteal phlegmon and abscess; stage III, orbital cellulitis; stage IV, orbital abscess; and stage V, ophthalmic vein and cavernous sinus thrombosis. The patients were categorized into 2 groups: preseptal (stage I) and postseptal (stage II-V).

 



 

Results:

Of the 80 children, 50 were male and the mean age was 6.8 years. Sinusitis and upper respiratory tract infection were the most common predisposing factors. Forty one percent of patients in stage I presented with symptoms that indicated postseptal involvement. The patients with postseptal involvement had a significantly higher rate of proptosis and limitation of extraocular motility. Bacterial pathogens were identified in 31 patients (39%), the 2 most common pathogens being Staphylococcus and Streptococcus. Ten patients (13%) had polymicrobial infection. Twenty three patients underwent sinus and/or orbital and/or intracranial surgery, including all 5 patients (100%) in stage IV, 3 of 6 patients (50%) in stage III, 13 of 35 patients (37%) in stage II, and 2 of 34 patients (6%) in stage I. Complete resolution without complication was achieved in 72 children. Eight patients had complications, including intracranial infection in 3, recollection of abscess in 2, ophthalmoplegia in 2, and corneal scar in 1.

 



 

Conclusion:

Proptosis and limitation of extraocular motility may be considered the most important signs on CT examination in children with suspicious orbital cellulitis. Given that polymicrobial infection is common, broad-spectrum antibiotics are indicated initially. Surgery should be considered not only when an abscess is demonstrated by CT scan but also if clinical deterioration occurs within 24 to 36 h of adequate intravenous antibiotic treatment.

 



 

Key words:

Cellulitis; Infection; Orbital diseases; Risk factors; Tomography, X-ray computed; Treatment outcome


 



 

J Microbiol Immunol Infect. 2007;40:518-524.