[Four cases of severe orbital cellulitis in children]

Abstract

Four children were treated at the Ophthalmology Department of Beijing Children's Hospital affiliated with Capital Medical University, including a female patient aged 9 years and 11 months with redness and swelling of the forehead accompanied by bilateral eyelid swelling for 3 days, a male 14-day-old infant with progressive worsening of the right eye redness and swelling accompanied by high fever, nasal congestion and a runny nose for 7 days, a boy aged 5 years and 9 months with the left eye and facial redness and swelling, black skin deposition, rupture, pus discharge and high fever for 2 days, and a 7-year-old male with the right eyelid redness and swelling accompanied by fever and acute lymphoblastic leukemia for 2 hours. The comprehensive blood routine examination showed C-reactive protein levels exceeded 140 mg/L and white blood cell counts exceeded 20×10⁹/L in all patients. Bacterial cultures of ocular secretions or pus were mainly positive for Streptococcus pyogenes, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa. Orbital imaging revealed orbital abscess formation (Chandler stage 4) in 2 patients and subperiosteal abscess and necrotizing fasciitis (Chandler stage 3) in 2 patients. According to the scoring criteria for the systemic inflammatory response syndrome, all four cases were diagnosed with severe orbital cellulitis. Systemic and ocular antibiotics were administered, along with local debridement and abscess incision and drainage. Four children recovered without any recurrence of infection. Two of them developed late-onset inner canthal deformity and eyelid abnormality, which were resolved by corrective surgery.