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Orbital cellulitis in children
Last reviewed: 05.07.2025
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Orbital cellulitis occurs when the inflammatory focus is localized behind the tarso-orbital fascia. It can be combined with extraorbital cellulitis.
[ Cause of orbital cellulitis in children
- Injury.
- Foreign body.
- Consequence of surgical intervention.
- Hematogenous, due to a general infectious disease.
- Secondary to necrotic neoblastoma.
- Rhinogenic.
Pathogens
- H. influenzae in newborns.
- Staph. aureus.
- Strep. pyogenes and Strep. pneumoniae.
- E. coli.
- Fungi and molds (in children with suppressed immunity and diabetes).
Symptoms of orbital cellulitis in children
- Exophthalmos.
- Pain.
- Swelling of the eyelids.
- Low vision.
- Chemosis.
- Limitation of eyeball mobility.
- Increased temperature and general malaise.
- Optic neuropathy leading to optic nerve atrophy.
- Keratitis associated with corneal exposure due to exophthalmos.
- Central retinal artery thrombosis.
- Subperiosteal abscess in combination with sinusitis.
- Orbital abscess.
- Cavernous sinus thrombosis.
- Meningitis.
- Brain abscess.
- Septicemia.
Where does it hurt?
What do need to examine?
How to examine?
Treatment of orbital cellulitis in children
The patient must be hospitalized.
Research
- To perform Gram staining and determine the sensitivity of the pathogen to antibiotics, a smear is taken:
- from the conjunctiva;
- from the nasopharynx.
- X-ray of the paranasal sinuses.
- CT to assess the degree of involvement of the orbit in the pathological process and to diagnose orbital and subperiosteal abscesses.
- Examination by an otolaryngologist.
- If necessary, see a dentist.
- Search for the source of inflammation in other organs.
- If meningitis is suspected, a lumbar puncture is performed.
- Blood culture for sterility.
It is recommended that studies be conducted in conjunction with a pediatrician and infectious disease specialist.
- In cases where Gram staining allows one to isolate a specific pathogen, antibiotic treatment is prescribed while awaiting the results of other studies, taking into account the sensitivity of the microflora.
- In cases where the causative agent of the inflammatory process cannot be detected, it is possible:
- intravenous administration of chloramphenicol (daily dose 75-100 mg/kg body weight) with ampicillin (daily dose 150 mg/kg body weight);
- cephalosporins, such as ceftazidime (daily dose 100-150 mg/kg body weight) or ceftriaxone (daily dose 100-150 mg/kg body weight) in combination with nafcillin or oxacillin (daily dose 150/200 mg/kg body weight).
Drainage of the abscess may be necessary.
It is not recommended to discharge the child from the medical institution until complete recovery. Antibacterial therapy is continued for at least a week after the temperature has returned to normal and positive dynamics have appeared. If these principles are not followed or treatment is carried out with inappropriate doses of antibiotics, an exacerbation of the disease, osteomyelitis and other complications may occur.
It is important to remember that the possibility of complications remains even when clinical symptoms subside. Changes in pupillary response may suggest the development of optic neuropathy or retinal vascular pathology; long-standing exophthalmos requires serial CT scans.