Who should manage acute periorbital cellulitis in children?

IntroductionPeriorbital cellulitis is inflammation of the eye anterior to the palpebral ligament. The sequeale may be life or vision threatening. There is no consensus on the optimal management strategies.MethodsA two year retrospective case note analysis was performed on all hospital admissions to a tertiary children's hospital with the diagnosis.Results226 notes were retrieved, 13 were excluded. The incidence of periorbital cellulitis was nearly 9 cases per month (8.875): the median length of stay was 2 days: all were treated with antibiotics. Only 7 children (3%) underwent surgical intervention.DiscussionDue to potentially serious intracranial and orbital complications, authors have previously argued that all patients with periorbital cellulitis need daily otorhinolaryngology assessment. This current review showed a much larger incidence than in the published literature, with the majority being managed by the paediatricians and ophthalmologists. Escalation to otorhinolaryngology when first line treatment has failed is a more appropriate use of resources.