Ho Chen-Fang, Huang Yhu-Chering, Wang Chao-Jen, Chiu Cheng-Hsun, Lin Tzou-Yien
Division of Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
J Microbiol Immunol Infect. 2007 Dec;40(6):518-24.
Bacterial infection of the orbital structures can affect all age groups, but is more frequent in pediatric populations. Prompt recognition, correct diagnosis, and adequate management are important if serious complications are to be avoided. This study sought to delineate the clinical, bacteriological and radiological findings, management and outcome of orbital cellulitis.
This retrospective study reviewed 80 children admitted to Chang Gung Children's Hospital with a diagnosis of orbital cellulitis who were staged by computed tomography (CT), between January 1999 and August 2005. The staging classification was as follows: stage I, inflammatory edema (preseptal); stage II, subperiosteal phlegmon and abscess; stage III, orbital cellulitis; stage IV, orbital abscess; and stage V, ophthalmic vein and cavernous sinus thrombosis. The patients were categorized into 2 groups: preseptal (stage I) and postseptal (stage II-V).
Of the 80 children, 50 were male and the mean age was 6.8 years. Sinusitis and upper respiratory tract infection were the most common predisposing factors. Forty one percent of patients in stage I presented with symptoms that indicated postseptal involvement. The patients with postseptal involvement had a significantly higher rate of proptosis and limitation of extraocular motility. Bacterial pathogens were identified in 31 patients (39%), the 2 most common pathogens being Staphylococcus and Streptococcus. Ten patients (13%) had polymicrobial infection. Twenty three patients underwent sinus and/or orbital and/or intracranial surgery, including all 5 patients (100%) in stage IV, 3 of 6 patients (50%) in stage III, 13 of 35 patients (37%) in stage II, and 2 of 34 patients (6%) in stage I. Complete resolution without complication was achieved in 72 children. Eight patients had complications, including intracranial infection in 3, recollection of abscess in 2, ophthalmoplegia in 2, and corneal scar in 1.
Proptosis and limitation of extraocular motility may be considered the most important signs on CT examination in children with suspicious orbital cellulitis. Given that polymicrobial infection is common, broad-spectrum antibiotics are indicated initially. Surgery should be considered not only when an abscess is demonstrated by CT scan but also if clinical deterioration occurs within 24 to 36 h of adequate intravenous antibiotic treatment.
眼眶结构的细菌感染可累及所有年龄组，但在儿童群体中更为常见。若要避免严重并发症，迅速识别、正确诊断及恰当处理至关重要。本研究旨在描述眼眶蜂窝织炎的临床、细菌学及影像学表现、处理方法及预后。
本回顾性研究纳入了1999年1月至2005年8月间入住长庚儿童医院、诊断为眼眶蜂窝织炎且经计算机断层扫描（CT）分期的80例儿童。分期分类如下：I期，炎性水肿（眶隔前）；II期，骨膜下蜂窝织炎及脓肿；III期，眼眶蜂窝织炎；IV期，眼眶脓肿；V期，眼静脉及海绵窦血栓形成。患者分为2组：眶隔前（I期）和眶隔后（II - V期）。
80例儿童中，男性50例，平均年龄6.8岁。鼻窦炎和上呼吸道感染是最常见的易感因素。I期患者中有41%出现提示眶隔后受累的症状。眶隔后受累的患者眼球突出和眼球运动受限的发生率显著更高。31例患者（39%）鉴定出细菌病原体，最常见的2种病原体是葡萄球菌和链球菌。10例患者（13%）有混合菌感染。23例患者接受了鼻窦和/或眼眶和/或颅内手术，包括IV期的所有5例患者（100%）、III期6例患者中的3例（50%）、II期35例患者中的13例（37%）以及I期34例患者中的2例（6%）。72例儿童完全康复且无并发症。8例患者出现并发症，包括颅内感染3例、脓肿复发2例、眼肌麻痹2例和角膜瘢痕1例。
对于可疑眼眶蜂窝织炎的儿童，眼球突出和眼球运动受限可能被认为是CT检查中最重要的体征。鉴于混合菌感染常见，初始应使用广谱抗生素。不仅在CT扫描显示有脓肿时，而且在充分静脉应用抗生素治疗24至36小时内临床病情恶化时，均应考虑手术治疗。
