title: Medical And Surgical Management Of Orbital Cellulitis In Children.
abstract: The purpose of this study was to identify features of orbital cellulitis that predict response to conservative treatment without surgical intervention and factors associated with a decision for surgery.
  
  
  
  The medical files of patients diagnosed with orbital cellulitis at a tertiary medical center in central Israel between 1995 and 2010 were reviewed for clinical data, diagnosis, complications, and type of treatment. Comparison was made between patients treated with antibiotics and patients treated with antibiotics and surgery.
  
  
  
  Fifty-one patients (35 male) with a mean age of 6.1 years were identified. Main clinical signs included fever (mean 38.5°C), proptosis (82.3%), extraocular motility restriction (74.5%), and ocular pain (41.1%). Forty-one patients were successfully treated with antibiotics and 10 required endoscopic sinus surgery. On between-group comparison, the surgery group had severe eye pain (p = 0.009), severe proptosis (P = 0.02), longer intravenous antibiotic treatment (13.2 vs. 9.2 days, p = 0.04), and several imaging findings. Additional factors associated with surgical intervention included older children, subperiorbital abscess, larger dimension of the abscess (mean 15 mm), involvement of frontal sinuses and findings of intraorbital air bubbles. There was no visual deterioration in either group and no late sequelae.
  
  
  
  Factors associated with surgery included age older than 9 years, severe ocular pain, severe proptosis, and subperiorbital large abscess. These may be used for early identification of patients at risk of failure of only medical management.
authors.affiliation: Pediatric Ophthalmology Unit
authors.forename: Ronit
authors.initials: R
authors.lastname: Friling
authors.affiliation: B,  Schneider Children’s Medical Center of Israel, Petach Tikva|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
authors.forename: Ben-Zion
authors.initials: BZ
authors.lastname: Garty
authors.affiliation: Department of Imaging, Departments of Pediatrics|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
authors.forename: Liora
authors.initials: L
authors.lastname: Kornreich
authors.affiliation: B,  Schneider Children’s Medical Center of Israel, Petach Tikva|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
authors.forename: Oded
authors.initials: O
authors.lastname: Scheurman
authors.affiliation: Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva
authors.forename: Murat
authors.initials: M
authors.lastname: Hasanreisoglu
authors.affiliation: B,  Schneider Children’s Medical Center of Israel, Petach Tikva|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
authors.forename: Irit
authors.initials: I
authors.lastname: Taler
authors.affiliation: C,  Schneider Children’s Medical Center of Israel, Petach Tikva|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
authors.forename: Jacob
authors.initials: J
authors.lastname: Amir
authors.affiliation: A,  Schneider Children’s Medical Center of Israel, Petach Tikva|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
authors.forename: Gilat
authors.initials: G
authors.lastname: Livni
authors.affiliation: Pediatric Ophthalmology Unit|Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva|Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
authors.forename: Moshe
authors.initials: M
authors.lastname: Snir
mesh_terms: D000038:Abscess / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D061605:Administration, Intravenous; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005094:Exophthalmos / Q000209:etiology; D058447:Eye Pain / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054517:Orbital Cellulitis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D009916:Orbital Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D010256:Paranasal Sinuses / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002443:Ceftriaxone