From the Department of Pediatrics, Hospital Universitario La Paz.
Infectious Diseases Department, Hospital Universitario La Paz.
Pediatr Infect Dis J. 2021 Nov 1;40(11):969-974. doi: 10.1097/INF.0000000000003226.
Preseptal and orbital cellulitis are two types of infection surrounding the orbital septum with very different potential outcomes. Our aim was to describe key differential features of both conditions, laying special emphasis on diagnostic and therapeutic tools.
A retrospective review of patients admitted to a tertiary hospital over a 15-year period (January 2004-October 2019) was conducted. We included 198 patients with preseptal and 45 with orbital cellulitis. Descriptive statistics were performed to examine the available information.
Statistically significant differences were found between patients with preseptal and orbital cellulitis regarding age (3.9 ± 2.14 vs. 7.5 ± 4.24 years), presence of fever (51.5% vs. 82.2%), and preexisting sinusitis (2% vs. 77.8%) (all P < 0.001). Diplopia, ophthalmoplegia and proptosis were only present in orbital cellulitis (P < 0.001). Median values of C-reactive protein were significantly higher among children with orbital involvement [136.35 mg/L (IQR 74.08-168.98) vs. 17.85 (IQR 6.33-50.10), P < 0.0001]. A CRP>120 mg/L cut-off point for orbital cellulitis was obtained. Early CT scans were performed in 75.6% of suspected orbital cellulitis and helped detecting complications at an early stage. Abscesses were revealed in 70.6% of cases, especially medial subperiosteal abscesses (58.8%). All patients received intravenous antibiotics, whereas corticosteroids were preferred in patients with orbital implication (8.6% vs. 73.3%, P < 0.001). Only 26.7% of patients required additional surgery.
Clinical presentation and CRP are extremely sensitive for differential diagnosis of preseptal and orbital cellulitis. Prompt initiation of intravenous antibiotics is mandatory and can prevent surgical procedures even in cases with incipient abscesses.
眶隔前和眶隔后蜂窝织炎是两种围绕眶隔的感染类型，其潜在后果有很大的不同。我们的目的是描述这两种疾病的关键鉴别特征，特别强调诊断和治疗工具。
对一家三级医院在 15 年期间（2004 年 1 月至 2019 年 10 月）收治的患者进行回顾性分析。我们纳入了 198 例眶隔前蜂窝织炎患者和 45 例眶隔后蜂窝织炎患者。进行描述性统计分析以检查可用信息。
眶隔前蜂窝织炎患者和眶隔后蜂窝织炎患者在年龄（3.9 ± 2.14 岁与 7.5 ± 4.24 岁）、发热（51.5%与 82.2%）和存在窦炎（2%与 77.8%）方面存在统计学差异（均 P < 0.001）。复视、眼肌麻痹和眼球突出仅存在于眶隔后蜂窝织炎患者中（均 P < 0.001）。有眶部受累的儿童的 C 反应蛋白中位数明显更高[136.35 mg/L（IQR 74.08-168.98）与 17.85（IQR 6.33-50.10），P < 0.0001]。获得了 C 反应蛋白>120 mg/L 的临界值，用于诊断眶隔后蜂窝织炎。75.6%的疑似眶隔后蜂窝织炎患者进行了早期 CT 扫描，有助于早期发现并发症。70.6%的患者显示有脓肿，特别是内侧骨膜下脓肿（58.8%）。所有患者均接受静脉内抗生素治疗，而皮质类固醇更常用于眶部受累的患者（8.6%与 73.3%，P < 0.001）。仅 26.7%的患者需要额外的手术。
临床表现和 C 反应蛋白对于眶隔前蜂窝织炎和眶隔后蜂窝织炎的鉴别诊断非常敏感。必须立即开始静脉内抗生素治疗，即使在出现初期脓肿的情况下也可以防止手术。
