Do children generally develop preseptal or orbital cellulitis?

From the Guidelines

Children generally get preseptal cellulitis more frequently than orbital cellulitis. This is because preseptal cellulitis is an infection of the eyelid and surrounding soft tissues anterior to the orbital septum, while orbital cellulitis affects tissues behind the septum within the eye socket. According to the clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years 1, the most common complication of acute sinusitis involves the orbit in children with ethmoid sinusitis who are younger than 5 years, but this does not necessarily mean they develop orbital cellulitis.

Key Points

• Preseptal cellulitis is more common in children due to their increased susceptibility to upper respiratory infections and their anatomically thinner facial bones, allowing easier spread of infection from adjacent structures.
• Orbital cellulitis is less common but more serious, often resulting from sinusitis complications, and typically requires hospitalization with IV antibiotics.
• The guideline recommends obtaining contrast-enhanced CT images when children are suspected of having serious complications of acute bacterial sinusitis, such as orbital cellulitis, to determine the presence of abscesses, which may require surgical intervention 1.
• Treatment for preseptal cellulitis usually involves antibiotics like amoxicillin-clavulanate or cefdinir for 7-10 days, while more severe cases or orbital cellulitis may require intravenous antibiotics like ceftriaxone or ampicillin-sulbactam.

Considerations

• The benefits of aggressive management, including avoiding sequelae and determining the presence of abscesses, outweigh the harms, such as exposure to ionizing radiation for CT scans and the need for sedation for MRI 1.
• The role of patient preference is limited in this context, and the strength of the recommendation is strong, emphasizing the importance of prompt and appropriate management of suspected orbital complications in children with acute bacterial sinusitis 1.

From the Research

Prevalence of Periorbital and Orbital Cellulitis in Children

• Periorbital cellulitis is more common than orbital cellulitis in children, with a frequency of 83% versus 17% 2.
• Another study found that periorbital cellulitis occurred in 87% of cases, while orbital cellulitis occurred in 13% of cases 3.
• The age distribution of periorbital and orbital cellulitis varies, with periorbital cellulitis more common in children under 5 years old, and orbital cellulitis more common in children over 5 years old 2, 3.

Predisposing Factors

• Upper respiratory infection and trauma to the eyelids are common predisposing factors for periorbital cellulitis 2, 3.
• Sinusitis is a more common predisposing factor for orbital cellulitis, occurring in 79% of cases 2.
• The most common isolated pathogens in periorbital and orbital cellulitis are Staphylococcus aureus, Streptococcus pneumoniae, and Staphylococcus epidermidis 2.

Treatment and Management

• Intravenous antibiotics are an effective treatment for most cases of periorbital and orbital cellulitis 2, 3.
• Some cases may require surgical intervention, particularly those with extensive infection or complications such as abscesses 2, 3.
• The use of corticosteroids as an adjunct to antibiotic therapy may be beneficial in reducing inflammation and improving outcomes in orbital cellulitis 4, 5.