Management of Periorbital and Orbital Cellulitis at the Pediatric Emergency Department

Abstract

Background : Orbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the vital and functional prognosis. This study aimed to analyze the epidemiological, therapeutic and evolutional aspects of orbital cellulitis cases treated at the pediatric emergency unit. Patients and methods: retrospective study including all the children aged between 1 month and 15 years treated for orbital cellulitis at the pediatric emergency unit of the Mohamed VI University Hospital of Marrakech over a period of 9 years (1st January 2010-31st December 2018). Results: 129 cases of orbital cellulitis were gathered. Age varied between 1 month and 15 years with a median of age of 4.3 years. Feminine predominance (54%) was noted (sex ratio of 0.84). Preseptal cellulitis had the lead with 101 cases (78.2%). It mainly breaks through sinuses (24%). Fever was present in 101 patients (78.2%). Palpebral edema was constant. Exophthalmia was noted in 18 patients (13.9%), chemosis in 29 cases (22.4%) while ptosis was found in one patient. Bacteriological study conducted in 12 cases was positive in 7 cases. An orbital CT scan was performed in all cases of our study, showing preseptal cellulitis in 101 patients (78.2%), orbital cellulitis in 11 cases (8.5%), subperiosteal abscess in 15 cases (11.6%) and orbital abscess in 2 cases (1.5%). The medical treatment consisted of ceftriaxone, metronidazole and aminoside or amoxicilline clavulanic acid. Surgical treatment was indicated in 8 patients : 3 cases of orbital abscess, 2 cases of periosteal abscess, and 3 cases of abscessed collection of the soft tissues. The evolution was beneficial in all our patients. Conclusion: The majority of our cases had a positive evolution highlighting the advantage of an early diagnosis, and adapted antibiotic and a multidisciplinary patient care making the need for surgery rarely necessary.