Indicators for imaging in periorbital cellulitis secondary to rhinosinusitis
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Our objective was to identify the clinical indicators for subperiosteal orbital abscess (SPOA) among patients who present with periorbital cellulitis secondary to rhinosinusitis, and to evaluate the need for performing a computerized tomography (CT) scan.
A retrospective cohort study of all patients admitted to our tertiary care emergency department between 2006 and 2014 was conducted. Included were healthy patients with acute periorbital cellulitis secondary to rhinosinusitis. Variables analyzed included age, gender, duration of symptoms, previous antibiotic therapy, highest recorded temperature, physical examination findings, ophthalmologist’s examination results, laboratory results, and interpretation of imaging studies, when performed.
Of the 123 identified patients, 78 (63%) were males, with a mean age of 4 years (range 1–70). 68 patients were categorized as Chandler’s 1 disease, 2 as Chandler’s 2, and 53 as Chandler’s 3. 68 patients underwent a CT scan, of those 53 had SPOA. Proptosis and ophthalmoplegia were strongly associated with the presence of an abscess (P < 0.001). However, 14 patients with no ophthalmoplegia or proptosis who underwent a CT scan were older (mean age, 10 years; P < 0.028), and had higher neutrophil count of 78 versus 59% (P = 0.01). This group of patients had a clinically rapidly progressive disease, receiving wider broad-spectrum antibiotics or had their antibiotic treatment replaced to broader spectrum antibiotics through their course of treatment (48.2% compared to only 6.1%).
We confirmed that patients with proptosis and/or limitation of extraocular movements are at high risk for developing SPOA, yet many do not have these predictors. Other features can identify patients who do not have proptosis and/or limitation of extraocular movements but do have significant risk of SPOA, and in these cases performing an imaging study is strongly suggested.
KeywordsAcute rhinosinusitis Orbital complication Computerized tomography Subperiosteal orbital abscess
Subperiosteal orbital abscess
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
There is no direct or indirect commercial financial incentive associated with publishing the article; there is no extra-institutional funding; there are no sources of financial support, corporate involvement, patent holdings, etc for our research/study.
This article does not contain any studies with human participants or animals performed by any of the authors.
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