Periorbital Cellulitis in Children

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Abstract
Inflammation of periorbital tissues is common in pediatric patients, but little information regarding guidelines for treatment is available. The patient with periorbital cellulitis has erythema and swelling of the soft tissues of the eye. The condition is distinguished from more severe orbital involvement by the absence of ophthalmoplegia, proptosis, or impaired vision (Table I).1 This review was initiated to develop bacteriologic data for the treatment of periorbital cellulitis. PATIENT POPULATION Patients hospitalized at the Children's Hospital of Denver between December 1972 and June 1976 with the diagnosis of orbital or periorbital cellulitis were reviewed. Patients with periorbital cellulitis (lid swelling and erythema without ophthalmoplegia, proptosis, or impaired vision) were analyzed; clinical, bacteriologic, and roentgenographic data were obtained. A positive blood or cellulitis aspirate culture was required to prove a bacteriologic cause. Roentgenograms were interpreted by two pediatric radiologists. FINDINGS Seventy-one cases of periorbital cellulitis without orbital involvement were identified during the study period. Children ranged in age from 10 days to 18 years; 41 (58%) were 4 years of age or younger. The right periorbital tissues were involved in 39 patients (55%) and the left in 28 (39%); bilateral involvement was noted in four. A temperature greater than 37.8 C (100 F) was documented on the day of admission in 52 (73%) children; 34 (48%) had temperatures greater than 38.3 C (101 F). Although not a presenting complaint, 19 (27%) exhibited mild conjunctival hyperemia without purulent discharge. Clinical sinusitis manifested by a history of drainage, pain, or local tenderness was noted in ten (14%) patients.

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