Pediatric Orbital Cellulitis

  • Etiology:
    — Orbital septum is border between pre septal space and post septal space
    — Preseptal orbital cellulitis typically is extension of infection related to face or teeth and is limited to the soft tissues anterior to the orbital septum
    — Postseptal orbital cellulitis typically caused by or is complication of ethmoidal and maxillary sinusitis
  • Imaging:
    — Ethmoid and maxillary sinusitis
    — Pre-septal or post-septal cellulitis
    — Periorbital or orbital cellulitis
    — Subperiosteal or orbital abscess
    — Nonopacificed cavernous sinus
  • Imaging grading system:
    — Preseptal cellulitis – Chandler Type I
    — Orbital cellulitis – Chandler Type II
    — Subperiosteal abscess – Chandler Type III
    — Orbital abscess – Chandler Type IV
    — Cavernous sinus thrombosis – Chandler Type V
  • DDX:
  • Complications:
    — Postseptal orbital cellulitis: Subperiosteal abscess next to lamina papyrcea forms from direct spread of infection through neurovascular foramina or via osseous defects in bone
    — Thrombosis of superior ophthalmic vein
    — Orbital apex syndrome (deficits of cranial nerves 3 and 4)
    — Cavernous sinus thrombosis (deficits of cranial nerves 3, 4, 5, 6)
  • Treatment:
  • Clinical:

Radiology Cases of Orbital Cellulitis

Radiology Cases of Preseptal Cellulitis

Radiology Cases of Orbital Cellulitis

CT of orbital cellulitis
Axial CT with contrast of the orbits shows opacification of the bilateral ethmoid and maxillary sinuses along with pre and post-septal inflammation of the right orbit. No subperiosteal abscess was seen.

Radiology Cases of Subperiosteal Abscess

CT of subperiosteal abscess
Axial CT with contrast of the orbits shows opacification of the left ethmoid sinus and bilateral sphenoid sinuses along with pre and post-septal inflammation of the left orbit. A lenticular fluid collection with rim enhancement is present along the medial wall of the left orbit.
CT of sinusitis with preseptal cellulitis and a subperiosteal abscess
Axial CT with contrast of the orbits (above) shows opacification of the ethmoid sinuses and sphenoid sinus along with right preseptal soft tissue swelling. There is a fluid collection with rim enhancment medially next to the wall of the right ethmoid sinus which is better seen on the coronal CT (below).
CT of orbital cellulitis and subperiosteal abscess
Axial CT with contrast of the orbits (above) shows opacification of the right ethmoid sinus, inflammatory changes within the right orbit, and a low density oval fluid collection with an enhancing wall between the right medial rectus muscle and the right ethmoid sinus. Coronal CT (below) shows how this fluid collection is displacing the right medial rectus muscle laterally.

Clinical Cases of Orbital Cellulitis

Clinical image of orbital cellulitis
Clinical image shows extensive erythema and swelling of the right orbit. Copious nasal secretions are also present.
Clinical image of orbital cellulitis
Clinical image shows extensive erythema and swelling of the right orbit.