Spot the signs, save the sight: pediatric orbital cellulitis from rhinosinusitis
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20250118Keywords:
Acute rhinosinusitis, Orbital cellulitis, Preseptal cellulitis, post-septal cellulitis, Transnasal Endoscopic Orbital Decompression surgeryAbstract
Orbital cellulitis is a potentially devastating condition characterized by acute infection of the orbital contents. While it can occur at any age, it is more prevalent in the pediatric population. Key red flag signs include conjunctival chemosis, proptosis, restricted ocular movements, and reduced visual acuity. Recognizing these signs is crucial for diagnosing post-septal cellulitis, which requires aggressive management involving surgical intervention and parenteral antibiotics to prevent serious complications. This case series presents 8 cases of orbital cellulitis encompassing 3 boys and 5 girls aged 3 to 15 years who were thoroughly assessed, investigated and followed up. Three patients who presented with pre-septal cellulitis were managed conservatively with antibiotics, antihistamines and nasal decongestants while the remaining five who presented with post-septal cellulitis underwent transnasal endoscopic orbital decompression surgery. Post-operative recovery was good. All patients are currently asymptomatic and are under follow-up.
Metrics
References
Saltagi MZ, Rabbani CC, Patel KS, Wannemuehler TJ, Chundury RV, Illing EA, et al. Orbital complications of acute sinusitis in pediatric patients: management of chandler iii patients. allergy rhinol (Providence). 2022;13:21526575221097311. DOI: https://doi.org/10.1177/21526575221097311
Georgakopoulos CD, Eliopoulou MI, Stasinos S, Exarchou A, Pharmakakis N, Varvarigou A. Periorbital and orbital cellulitis: a 10-year review of hospitalized children. Eur J Ophthalmol. 2010;20(6):1066–72. DOI: https://doi.org/10.1177/112067211002000607
PullaratAN, Mohamed Faisal CK, Nampoothiri MP, Suma R. A descriptive study of the patients with orbital complication of acute and chronic sinusitis. Int J Otorhinolaryngol Head Neck Surg. 2018;4:990-6. DOI: https://doi.org/10.18203/issn.2454-5929.ijohns20182495
Chaudhry IA, Al-Rashed W, Arat YO. The hot orbit: orbital cellulitis. Middle East Afr J Ophthalmol. 2012;19(1):34-42. DOI: https://doi.org/10.4103/0974-9233.92114
McKinley SH, Yen MT, Miller AM, Yen KG. Microbiology of pediatric orbital cellulitis. Am J Ophthalmol. 2007;144(4):497-501. DOI: https://doi.org/10.1016/j.ajo.2007.04.049
Kumar A, Chauhan JPS, Bhadouriya SKS, Bharti B, Narain P, Singh J. Orbital complications of ENT diseases. Int J Otorhinolaryngol Head Neck Surg. 2018;4:210-6. DOI: https://doi.org/10.18203/issn.2454-5929.ijohns20175627
Meara DJ. Sinonasal disease and orbital cellulitis in children. Oral Maxillofac Surg Clin North Am. 2012;24(3):487-96. DOI: https://doi.org/10.1016/j.coms.2012.05.002
Thomas SA, Pillai S, Moideen SP. Role of transnasal endoscopic surgery for the management of orbital diseases. Romanian J Rhinol. 2021;11(44):2478. DOI: https://doi.org/10.2478/rjr-2021-0026
Yadalla D, Jayagayathri R, Padmanaban K, Ramasamy R, Rammohan R, Nisar SP, et al. Bacterial orbital cellulitis-A review. Indian J Ophthalmol. 2023;71(7):2687-93. DOI: https://doi.org/10.4103/IJO.IJO_3283_22
Danishyar A, Sergent SR. Orbital Cellulitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024. Available at: https://www.ncbi.nlm.nih.gov. Accessed on 21 August 2024.
Harugop AKS, Mudhol RS, Bhimanapati D, Soni S, Bellad SA, Achuta A, et al. Varied orbital manifestations of paranasal sinus disease Int J Otorhinolaryngol Head Neck Surg. 2019;5:1061-4. DOI: https://doi.org/10.18203/issn.2454-5929.ijohns20192730
Weber AL, Mikulis DK. Inflammatory disorders of the paranasal sinuses and their complications. Radiol Clin North Am. 1987;3:575-6. DOI: https://doi.org/10.1016/S0033-8389(22)02262-X
Kator C, Dominic C, Ajike S. Management of Bilateral Orbital Cellulitis in a 41-Year-Old Man. Nigerian J of Ophthalmol. 2014;22(1):50-5. DOI: https://doi.org/10.4103/0189-9171.142758
Lucian L, Elena D, Andreea N. Orbital cellulitis-complication of an untreated rhinosinusitis: Case report. Roman J Rhinol. 2023;13:83-9. DOI: https://doi.org/10.2478/rjr-2023-0014
Tsirouki T, Dastiridou AI, Ibánez Flores N, Cerpa JC, Moschos MM, Brazitikos P, et al. Orbital cellulitis. Surv Ophthalmol. 2018;63(4):534-53. DOI: https://doi.org/10.1016/j.survophthal.2017.12.001
Anosike BI, Ganapathy V, Nakamura MM. Epidemiology and Management of Orbital Cellulitis in Children. J Pediatric Infect Dis Soc. 2022;11(5):214-20. DOI: https://doi.org/10.1093/jpids/piac006
Wong SJ, Levi J. Management of pediatric orbital cellulitis: A systematic review. Int J Pediatr Otorhinolaryngol. 2018;110:123-9. DOI: https://doi.org/10.1016/j.ijporl.2018.05.006
Fakhri S, Pereira K. Endoscopic Management of Orbital Abscesses, Otolaryngologic Clinics of North America. 2006;39(5):1037-47. DOI: https://doi.org/10.1016/j.otc.2006.06.001
Kayhan FT, Sayin I, Yazici ZM, Erdur O. Management of orbital subperiosteal abscess. J Craniofac Surg. 2010;21(4):1114-7. DOI: https://doi.org/10.1097/SCS.0b013e3181e1b50d
Presutti L, Lucidi D, Spagnolo F, Molinari G, Piccinini S, Alicandri-Ciufelli M. Surgical multidisciplinary approach of orbital complications of sinonasal inflammatory disorders. Acta Otorhinolaryngol Ital. 2021;41(1):108-15. DOI: https://doi.org/10.14639/0392-100X-suppl.1-41-2021-11