Indian Journal of Ophthalmology

: 1999  |  Volume : 47  |  Issue : 1  |  Page : 37--38

Management of orbital cellulitis in a child

NR Rangaraj, Murali Ariga, Krishna Kumar, Kuruvilla Thomas 
 Sundaram Medical Foundation,Chennai, India

Correspondence Address:
N R Rangaraj
Sundaram Medical Foundation, Shanti Colony, 4th Avenue, Anna Nagar, Chennai - 600 040

How to cite this article:
Rangaraj N R, Ariga M, Kumar K, Thomas K. Management of orbital cellulitis in a child.Indian J Ophthalmol 1999;47:37-38

How to cite this URL:
Rangaraj N R, Ariga M, Kumar K, Thomas K. Management of orbital cellulitis in a child. Indian J Ophthalmol [serial online] 1999 [cited 2023 Mar 22 ];47:37-38
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Full Text

Orbital cellulitis, defined as eyelid erytheme and edema, proptosis, ophthalmoplegia, with or without loss of visual acuity, is a rare but severe infectious disease. We report one such case that presented to us which was managed using an innovative and novel approach.

 Case Report

An 8-year-old boy presented to us with complaints of pain and swelling of one week duration and loss of vision in left eye of 2 days duration. There was no history of trauma.

On examination, the left eye vision was hand movements close to face and right eye was 6/6, N6. The external examination of the left eye showed painful ophthalmoplegia with restriction of ocular movements in all directions corresponding to a dysfunction of a combination of the third, fourth and sixth cranial nerves. Proptosis in the left eye was axial, with diffuse swelling of both upper and lower lids, and chemosis of the bulbar conjunctiva; cornea was clear, and pupillary light reaction was sluggish. The right eye was normal. Fundus examination in the left eye showed severe papilledema. The child had low-grade fever, was mildly toxic and the blood picture at admission was: total WBC count 12xl0[9] /I; differential WBC count: neutrophils, 66%; lymphocytes, 33%; eosinophils, 01%; and hemoglobin, 139g/l. The contrast CT scan of axial [Figure:1] and coronal [Figure:2] orbits indicated a well-defined, oval hyperdense lesion showing enhancement. The lesion was located in the medial aspect of the left orbit displacing and distorting the medial rectus with lateral displacement of the optic nerve. The ethmoid sinus was normal.

The child was put on intravenous antibiotics and steroids before surgical intervention.[1] Functional endoscopic sinus surgery was contemplated in view of the proximity of the abscess to the medial wall. An endoscopic opening of the medial wall of the bulla ethmoidalis and of the lamina papyracea was performed under general anaesthesia. The culture of the drained material grew Staphylococcus aureus with senstivity to cloxacillin. The orbital swelling resolved dramatically by the third postoperative day and the visual acuity in the left eye was 6/9, N6. Fundus examination of the left eye at the end of one week was normal, and the papilledema had resolved completely.


Management consists of early diagnosis and surgical drainage of the subperiosteal abscess to prevent blindness and intracranial complications. The ethmoid is the predominantly involved sinus but in this case the CT scan showed no evidence of its involvement. CT scans help confirm clinical diagnosis and locate the lesion but have no predictive value in the clinical course.[2] Ophthalmoplegia and acute fall of vision are early clinical indications for surgery. Surgical management of orbital subperiostial abscess includes open drainage through an external ethmoidectomy approach. Endonasal endoscopic surgery now offers a safe approach to the drainage of the subperiosteal abscess and quick rehabilitation[3,4] with no external scar.


1McCracken GH, Lebel MH. Dexamethasone therapy for bacterial meningitis in infants and children. Am J Dis Child 1989;143:287.
2Harris GJ. Subperiosteal abscess of the orbit: computer tomography and the clinical course. Ophthal Plast Reconstr Surg 1996;12:l-8.
3El-Silimy O. The place of endonasal endoscopy in the treatment of orbital cellulitis. Rhinology 1995;33:93-96.
4Deutsch E, Eilon A, Hevron I. Functional endoscopic sinus surgery of orbital subperiosteal abscess in children. Int J Fed Otorhinolaryngol 1996;34:181-90