[Pediatric orbital cellulitis without sinusitis: report of four cases].
BACKGROUND
Pediatric orbital cellulitis is most often caused by ethmoid sinusitis. We present a description of 4 atypical cases of orbital cellulitis without sinusitis.


METHODS
A 4-day-old girl presented with medical canthal swelling and preseptal cellulitis caused by bilateral congenital dacryocystoceles. The second patient was an 8-year-old boy seen for infectious conjunctivitis complicated by preseptal cellulitis without sinusitis. Conjunctival cultures revealed Neisseria gonorrheae. The next patient, a 5-month-old boy, presented with lid swelling, fever, proptosis and epiphora. It was caused by dacryocystitis extending into the ethmoid and complicated by a sub-periostal abscess with mass effect on the globe. The fourth patient was a 10-year-old boy referred for inflammatory eyelid edema and severe non-axial proptosis. Imaging revealed an orbital tumor; the diagnosis of rhabdomyosarcoma was confirmed by anatomopathology.


CONCLUSIONS
Thorough etiologic work-up of orbital cellulitis in children will prevent missing a non-sinus-based cause such as lacrimal infections, conjunctivitis secondary to atypical pathogens, or even tumors. All patients should undergo a detailed clinical examination, orbital imaging and microbiological testing.


CONCLUSIONS
Orbital cellulitis in children poses diagnostic and therapeutic difficulties due to the many possible etiologies. Aside from sinusitis, the most important etiologies to pursue are lacrimal system infections and tumors. When confronted with a non-specific clinical presentation, thorough etiologic work-up is essential, in view of the potential life-threatening, functional and social implications.
Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France. Electronic address: veronique.promelle@yahoo.fr.
V
V
Promelle
Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France.
D
D
Bennai
Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France.
A
A
Drimbea
Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France.
S
S
Milazzo
Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France.
D
D
Bremond-Gignac
D001763:Blepharoptosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D002648:Child; D003937:Diagnosis, Differential; D004487:Edema / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005094:Exophthalmos / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007299:Insect Bites and Stings / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D054517:Orbital Cellulitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D009918:Orbital Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D018232:Rhabdomyosarcoma, Alveolar / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy
Cellulites orbitaires; Conjonctivite; Dacryocystite; Enfant; Exophtalmie; Tumeur; children; conjunctivitis; dacryocystitis; etiology; orbital cellulitis; proptosis; tumor; Étiologie