Long-Term Ophthalmic Outcomes in Pediatric Orbital Cellulitis: A Prospective, Multidisciplinary Study From a Tertiary-Care Referral Institute.

Purpose: To analyze the clinical profile, radiological features, and ophthalmic outcomes of the multidisciplinary management of children with pediatric orbital cellulitis.

Methods: A prospective, interventional study of patients diagnosed as having pediatric orbital cellulitis was conducted. A complete history, clinical examination, laboratory work-up, radiology (computed tomography [CT]), multidisciplinary consultations (otolaryngology, pediatrics, and microbiology), and treatment plan were obtained for all children. The patients were admitted to the hospital and administered intravenous broad-spectrum antibiotics. Orbital and subperiosteal abscesses were drained via an endonasal or external route. Functional endoscopic sinus surgery was performed when necessary. After a minimum follow-up of 12 months, visual acuity, pupillary reaction, extraocular movements, and proptosis were evaluated as the outcome measures.

Results: Forty patients (male = 28, 70%) had unilateral presentation of pediatric orbital cellulitis at a mean age of 7.5 years (range: 4 to 12 years). At presentation, all patients had eyelid edema, conjunctival congestion, and chemosis: 38 (95%) had proptosis, 36 (90%) had decreased extraocular movements and pain, 16 (40%) had a relative afferent pupillary defect, and 6 (15%) had exposure keratitis and optic disc edema. CT scans showed sinusitis in 30 (75%) patients, orbital abscess in 14 (35%) patients, and subperiosteal abscess in 5 (12.5%) patients. At a mean follow-up of 15 months, 30 (75%) patients had complete success, 8 (20%) patients had partial success, and the treatment failed in 2 (5%) patients. No patient had any life-threatening complications.

Conclusions: The multidisciplinary management of pediatric orbital cellulitis provides satisfactory long-term ophthalmic outcomes. Ethmoidal sinusitis is the most common etiology of pediatric orbital cellulitis, and endoscopic abscess drainage and functional endoscopic sinus surgery are minimally invasive and provide rapid relief in children. [J Pediatr Ophthalmol Strabismus. 2019;56(5):333-339.].