Pediatric emergency medicine trisk 4041 4041

FIGURE 123.5 CT scan of a child with right-sided orbital cellulitis demonstrating retro-orbital
inflammation and a subperiosteal abscess.

Diagnostic Testing. Imaging is not routinely indicated in periorbital cellulitis. In
patients with concern for orbital cellulitis, CT or MRI scanning is used to confirm
the diagnosis and detect its complications including subperiosteal abscess, orbital
abscess, cavernous sinus thrombosis, and/or brain abscess. An MRI spares the
patient radiation exposure and can readily identify orbital disease that can mimic
orbital cellulitis such as tumor, hemorrhage, or inflammatory pseudotumor. CT
imaging however is cheaper, more readily available, less likely to require
sedation, and affords excellent views of the bony orbital wall ( Fig. 123.5 ).
Contrast-enhanced imaging should generally be expedited in all cases with highrisk features including limitation or pain with eye movements, vision loss,
proptosis, signs of CNS involvement, inability to perform a reliable examination,
and cases of presumed periorbital cellulitis which do not improve on IV
antibiotics within 48 hours.
Management and Disposition. In otherwise well children who are beyond infancy
and have mild periorbital cellulitis and no systemic signs or symptoms, oral
antibiotics are appropriate. The prognosis for complete recovery without
complications is excellent. The patient should be reevaluated within 24 to 48
hours to ensure improvement. If no improvement occurs, the patient should then
be admitted for IV antibiotics.