Clinical Analysis Of Severe Orbital Cellulitis In Children

Objective To retrospectively study the etiology,treatment and prognosis of severe orbital cellulitis in children,and to explore the diagnosis and treatment of the disease and provide clinical basis.Methods The clinical data of 24 children with severe orbital cellulitis admitted to ophthalmology,otorhinolaryngology,ICU and pediatrics from February 2016 to February 2019 were retrospectively studied.Result1.Disease characteristics: The average age of onset was(6.21 + 4.43)years,and the age group of 3 ~ 5 years old was the majority,with a total of 11 patients(45.8%).There were17 males and 7 females.The average hospitalization days were(7.91±2.77)days in the drug treatment group and(14±5.93)days in the surgery combined with drug treatment group.There was a statistically significant difference between the two groups(P=0.005).Of all the cases,75% occurred in winter and spring.2.Etiology: 17 cases were secondary to acute sinusitis,3 cases secondary to simple respiratory tract infection,1 case of ipsilateral acute dacryocystitis,2 cases of blepharitis and 1 case of acute dacryocystitis.Acute sinusitis is the main cause of orbital cellulitis in children,accounting for about 70.8%,followed by simple respiratory infection,accounting for about 12.5%.3.Laboratory examination: All of them were examined for WBC in peripheral blood and CRP in serum at admission.There was no statistically significant differences in the WBC and CRP between the two groups(P>0.05).4.Pathogenic examination: Fourteen cases underwent bacterial culture: 5 cases of Staphylococcus aureus infection,including one of Streptococcus viride infection in the same time;1 case of Streptococcus pneumoniae infection and 8 cases of undeveloped bacterial culture.Staphylococcus aureus was the first pathogen in children with positive bacterial culture.5.Imaging examination showed eyelid and orbital inflammation,of which ethmoid sinusitis and maxillary sinusitis were the most common.There was a statistically significant difference in nasal anatomical variation between the two groups(P=0.038).The incidence of nasal anatomical variation was higher in the surgery group.6.Treatment: Thirteen cases were treated with operation,while the rest were treated conservatively.All the children recovered within one month without serious complications.Conclusion1.Children's orbital cellulitis is predominant in winter and spring.The age of onset is 3-5years.Acute sinusitis and respiratory tract infection are the main causes.The most common cause of orbital cellulitis is ethmoid sinusitis and maxillary sinusitis,which is related to the sequence of sinus development in children.Nasal anatomical variations(nasal septum deviation,nasal meatus stenosis,inferior turbinate hypertrophy/fracture,etc.)are correlated with the need for surgical intervention.2.Children with orbital cellulitis should undergo blood routine,CRP and imaging examinations in time to definite the severity of the disease,identify the etiology and guide the treatment plan.3.Children's orbital cellulitis should be treated according to the etiology first.Broad-spectrum antibiotics should be the first choice of drugs,especially Gram-positive cocci should be covered,and drug sensitivity test results should be adjusted in time.