Management of periorbital and orbital cellulitis

Swelling of the tissues surrounding the eye is a relatively common presentation in paediatric practice. Many of the mild, pre-septal cases of periorbital inflammation and infection are caused by insect bites, trauma and conjunctivitis. Frequently infection spreads from the ethmoid sinuses and invades orbital tissues. The distinction between pre-septal and orbital involvement can be difficult based on clinical examination only, and the research base supporting management of periorbital and orbital cellulitis is limited. This review addresses the role of investigations and the multi-disciplinary approach needed in order to establish accurate diagnosis, appropriate treatment and prevention of serious complications including blindness and venous sinus thrombosis.