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This paper discusses the clinical profile and multidisciplinary team (MDT) management outcomes in children treated for paediatric orbital cellulitis. This was a prospective study of 40 children with a mean age of 7.5 years (4-12). Unilateral orbital cellulitis cases had a mean duration of symptoms of three days (2-7). Seventy percent were male and 90% had elevated total leukocyte count with 80% having raised erythrocyte sedimentation rate (ESR). Swabs taken revealed Staph aureus and Strep pneumonia. All had preseptal soft tissue inflammation, 95% had orbital fat stranding, 37.5% had orbital abscess and 20% had subperiosteal abscess. Each child was admitted and treated with IV ceftriaxone, amikacin and metronidazole. Oral steroids were added on the third day. Average hospital stay was nine days. Twenty-three children had surgical draining of the orbital abscess. Mean follow-up was 15 months; 80% made a complete recovery and 10%, a partial recovery. Ten percent developed optic atrophy, relative afferent pupillary defect (RAPD), strabismus and exposure keratopathy. The authors conclude that record of clinical features at presentation, hospital admission and broad spectrum antibiotic treatment are essential for better outcomes. Any clinical deterioration during treatment warrants surgical intervention.

Long-term ophthalmic outcomes in pediatric orbital cellulitis: a prospective, multidisciplinary study from a tertiary-care referral institute.
Singh M, Negi A, Zadeng Z, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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