Management of Pediatric Orbital Cellulitis: Impact of Surgery and Corticosteroid Use on Clinical Outcomes

Pediatric Orbital Cellulitis Management

Abstract

Objective: To evaluate the clinical characteristics, treatment approaches including surgical intervention and systemic corticosteroid use, and clinical outcomes in pediatric patients with orbital cellulitis treated at a tertiary referral center.
Methods: Medical records of pediatric patients (aged 0–18 years) diagnosed with orbital cellulitis and treated between January 2015 and January 2025 were retrospectively reviewed. Demographic data, clinical findings, laboratory results, imaging features, microbiological culture results, treatment modalities (medical, surgical, and corticosteroid therapy), and clinical outcomes were analyzed. Statistical analyses were performed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation or median [interquartile range (IQR)], and categorical variables as frequencies and percentages. A p-value ≤0.05 was considered statistically significant.
Results: Fifty-eight patients (58 eyes) were included: 26 (44.8%) were female and 32 (55.2%) were male. The mean age was 7.1 ± 4.52 years, with a median age of 6.8 years (IQR: 2.6–12.2). Thirty patients (51.7%) were managed with medical therapy alone, while 28 (48.3%) underwent surgical intervention. The mean age was significantly higher in the surgical group compared to the medical group (9.3 ± 6 vs. 6.5 ± 4.4 years, p = 0.034). Subperiosteal abscesses were detected in 30 patients (51.7%), and 28 of these (93.3%) underwent surgical drainage. Abscesses were most commonly located at the medial orbital wall (73.3%). The overall surgical intervention rate was 48.3%. Mean hospital stay was significantly longer in the surgical group than in the medical group (8.8 ± 7.1 vs. 6.3 ± 3.2 days, p = 0.028). Systemic corticosteroids were administered to 24 patients (41.4%). Among surgically treated patients, 20 (71.4%) received corticosteroids. No significant difference in hospital stay was found between corticosteroid-treated and untreated surgical patients (8.2 ± 4.1 vs. 8.0 ± 3.9 days, p > 0.05). Leukocyte levels significantly decreased after treatment in both groups; however, no significant difference was found between the medical and surgical groups in pre- or post-treatment leukocyte counts (p > 0.05). Culture positivity was detected in 11 of 28 surgically treated patients (39.3%). The most common microorganisms were Streptococcus pyogenes and Streptococcus pneumoniae. Visual acuity significantly improved postoperatively in surgically treated patients. Complications occurred in 3 patients (5.2%): one had osteomyelitis and two had subdural empyema.
Conclusion: In pediatric orbital cellulitis, subperiosteal abscess and older age were associated with an increased need for surgical intervention and a longer hospitalization. Leukocyte count alone was not a reliable predictor of treatment approach. Systemic corticosteroid use did not significantly reduce the length of hospital stay among surgically treated patients. Multidisciplinary management in tertiary centers remains essential for optimal outcomes.