Orbital Cellulitis Occurs Across All Age Groups, Not Just in Children Under 5 Years
Orbital cellulitis can occur at any age, though it is more common in the pediatric population, with children under 5 years having a higher risk specifically when associated with ethmoid sinusitis. 1, 2
Age Distribution and Epidemiology
- Orbital cellulitis affects both children and adults, with a greater tendency to occur in the pediatric age group overall 2, 3
- The statement that it "only occurs in less than 5 years old children" is incorrect—individuals older than 15 years are actually more likely to harbor polymicrobial infections 4
- In one 10-year pediatric study, 62% of orbital cellulitis cases occurred in children older than 5 years of age, while periorbital cellulitis was more common in younger children (85% under 5 years) 5
Age-Specific Risk Patterns
The confusion likely stems from the specific association between ethmoid sinusitis and orbital complications:
- The American Academy of Pediatrics notes that orbital complications of ethmoid sinusitis are most common in children younger than 5 years 1
- However, this represents only one subset of orbital cellulitis cases—sinusitis accounts for approximately 45% of orbital cellulitis cases in children 6
- Other causes include trauma, retained foreign bodies, dental infections, and hematogenous spread from distant sites, which can occur at any age 2, 4
Clinical Implications by Age
Age influences the microbiology and presentation:
- Children typically present with Staphylococcus aureus or Streptococcus species as causative organisms 4, 5
- Adults and individuals older than 15 years are more likely to have polymicrobial infections requiring broader antibiotic coverage 4
- The average age of presentation in recent pediatric series was 7 years (range 1-17 years), demonstrating the wide age distribution 6
Common Pitfall to Avoid
Do not dismiss the possibility of orbital cellulitis in older children, adolescents, or adults based on age alone. The diagnosis requires clinical assessment for proptosis, impaired extraocular movements, decreased visual acuity, and ophthalmoplegia, regardless of patient age 7, 8. Delayed diagnosis in any age group can result in permanent blindness, intracranial complications, or death 9, 6.