Orbital Cellulitis and Ethmoiditis in Children

ENT:EYE:PEDIATRIC  EMERGENCY

Orbital complications of ethmoiditis primarily affect children. Although orbital cellulitis may be caused by acute frontal sinusitis, it is most frequently a complication of acute ethmoiditis. Unfortunately, the association of acute ethmoid and frontal sinusitis with orbital cellulites is often unrecognized. If the basic site of infection remains unknown, optimum therapy is delayed.

Orbital cellulitis is known to occur in three varying situations:

and It may appear as an extension from the orbital structures, most probably the paranasal sinuses, or the face and other head injuries. Venous drainage from the middle third of the face, including the paranasal sinuses, is mainly via the orbital veins, which are without valves allowing the passage of infection both interrogates and retrograde.

and It may occur due to direct inoculation of the orbit from trauma or surgery. Infectious material may be introduced into the orbit directly from accidental or surgical trauma.

and It may in certain instances represent a hematogenous spread from bacteremia. Bacteremia is the presence of bacteria in the bloodstream.

About 75 percent of orbital cellulitis cases are related to sinusitis, especially ethmoiditis. Ethmoid sinusitis is commonly due to aerobic non-spore-forming bacteria.

Symptoms of orbital cellulitis include:

and Erythema or edema of the eyelids (common to all orbital infections)

and Proptosis

and Ophthalmoplegia (suggestive of orbital cellulitis, orbital or subperiosteal abscess)

and High Fever

and Pain

and Decreased visual acuity (associated with advanced infection)

and Conjunctivitis or pinkeye

Orbital cellulitis is more prevalent in children over five years of age. This is because most cases of ethmoiditis are associated with ethmoid sinus which is more prevent in school going kids than in adults.

As already mentioned, orbital cellulitis is more prevalent in kids. So if you observe any of the above-mentioned symptoms in your child, rush him/her to the clinic.

Diagnosis:

By CT scan. The CT scan imaging is done after giving sedative like Pedicloryl syrup.

Treatment

If cellulitis becomes severe, one or both eyes may be affected, and eye sockets or sinus cavities may have to be drained. These surgical procedures should be performed by an ophthalmologist (eye specialist) or otolaryngologist (ear, nose and throat specialist).

The antibiotics with anti inflammatory drugs and short course of hydrocortisone do clear the cellulites. The abscesses which are more frequent in older children require surgical drainage. Surgical drainage is indicated when subperiosteal abscess is documented by CT scan.