Orbital Infections and Complications in Pediatric Patients

Orbital infections in children encompass a spectrum from periorbital cellulitis to deep-seated orbital cellulitis and abscess formation. These conditions most commonly arise from contiguous spread of sinusitis, especially ethmoidal or maxillary infections, but can also follow trauma, dental infections or systemic bacteremia. Clinical manifestations include eyelid swelling, erythema, pain on eye movement, fever and, in more severe cases, proptosis and ophthalmoplegia. Prompt recognition is vital to prevent sight-threatening and life-threatening sequelae such as vision loss, cavernous sinus thrombosis or intracranial extension. Diagnostic evaluation relies on clinical assessment augmented by imaging, typically contrast-enhanced computed tomography or magnetic resonance imaging, to distinguish preseptal from postseptal involvement and to identify subperiosteal or orbital abscesses. Management hinges on early empirical intravenous antibiotic therapy tailored to likely pathogens, with surgical drainage reserved for well-defined abscesses, rapid clinical deterioration or evidence of intracranial spread. A multidisciplinary approach involving paediatricians, ophthalmologists, otolaryngologists, radiologists and, when necessary, neurosurgeons or infectious disease specialists underpins best outcomes. Recent advances have explored ambulatory care pathways, minimising hospitalisation for mild cases, and emphasised the importance of interdisciplinary protocols to standardise care and reduce complications.

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Orbital Infections and Complications in Pediatric Patients publication trend

The graph below shows the total number of articles in orbital infections and complications in pediatric patients across all publications each year (not limited to Nature Index journals).

Technical terms

Orbital cellulitis: Infection of the orbital contents posterior to the orbital septum, with risk of vision-threatening and intracranial complications.

Periorbital cellulitis: Inflammation and infection confined to the eyelid and surrounding skin anterior to the orbital septum.

Subperiosteal abscess: Localised pus collection between the orbital bone and its periosteum, often necessitating surgical drainage.

Proptosis: Forward displacement of the eyeball, indicating increased orbital pressure or mass effect.

Intracranial extension: Spread of infection beyond the orbit into the cranial cavity, risking meningitis, venous thrombosis or brain abscess.

References

1. Evaluation of mild periorbital cellulitis and home‐based therapy in children—EPOCH study: A prospective single centre cohort study. Clinical and Experimental Ophthalmology (2023).
2. Odontogenic Orbital Cellulitis at the Crossroads of Surgeries: Multidisciplinary Management and Review. Diagnostics (2024).
3. Presentation and Management of Pediatric Orbital Cellulitis. Canadian Journal of Infectious Diseases and Medical Microbiology (2011).