Periorbital and orbital cellulitis in the Haemophilus influenzae vaccine era.

BACKGROUND

Prior to development of the Haemophilus-influenzae vaccine, a significant number of periorbital and orbital infections were associated with H influenzae type b bacteremia. The incidence of invasive H influenzae type b disease has decreased dramatically since the introduction of these vaccines. The effect of the H influenzae type b vaccine on the microbiology of periorbital and orbital infections has not been examined.

METHODS

Charts of 134 hospitalized patients with the discharge diagnosis of periorbital or orbital cellulitis from 1985 to 1995 were reviewed.

RESULTS

In contrast with studies performed in the pre-vaccine era, H influenzae type b was not a significant pathogen. The pathogen was isolated from only 2 of 133 blood cultures performed, and was not isolated from any of the 101 patients discharged after July 1987. Sinusitis, however, remains an important cause of these eye infections. Of patients who underwent radiographic evaluation, sinusitis was present in 96% of children with orbital cellulitis and 81% of patients with periorbital cellulitis.

CONCLUSIONS

H influenzae type b is no longer a significant pathogen in periorbital or orbital cellulitis and management should be modified accordingly.