Who should manage acute periorbital cellulitis in children?

INTRODUCTION: Periorbital cellulitis is inflammation of the eye anterior to the palpebral ligament. The sequeale may be life or vision threatening. There is no consensus on the optimal management strategies.

METHODS: A two year retrospective case note analysis was performed on all hospital admissions to a tertiary children's hospital with the diagnosis.

RESULTS: 226 notes were retrieved, 13 were excluded. The incidence of periorbital cellulitis was nearly 9 cases per month (8.875): the median length of stay was 2 days: all were treated with antibiotics. Only 7 children (3%) underwent surgical intervention.

DISCUSSION: Due to potentially serious intracranial and orbital complications, authors have previously argued that all patients with periorbital cellulitis need daily otorhinolaryngology assessment. This current review showed a much larger incidence than in the published literature, with the majority being managed by the paediatricians and ophthalmologists. Escalation to otorhinolaryngology when first line treatment has failed is a more appropriate use of resources.