Pediatric orbital cellulitis with globe tenting may not predict devastating vision loss

This paper presents the visual outcomes of children with orbital cellulitis and globe tenting.

Study design

The authors performed a retrospective review of 46 consecutive pediatric orbital cellulitis patients, and compared the outcomes of those with or without globe tenting. Patients were included in the study if they had a diagnosis of orbital cellulitis and available neuroimaging data. Globe tenting was measured bilaterally using tangent lines across the posterior globe margin. Tenting was defined as a posterior globe angle less than or equal to 130 degrees.

Outcomes

Four of 46 patients had radiographic globe tenting and pre- and post-treatment visual acuity. All patients in both groups had unilateral disease secondary to sinusititis. Abscess was noted in all 4 patients with globe tenting and 20/30 patients without globe tenting. Surgical intervention occurred at a mean time of 1.5 days with tenting and 4 days without tenting, suggesting a trend towards quicker surgical intervention in those with tenting.

All patients with globe tenting had a visual acuity of 20/20, which was statisticlaly comparable to those without globe tenting.

Limitations

This study was limited by its retrospective study design. Quicker surgical intervention in those with tenting may have resulted in better visual outcomes and types of surgical intervention not detailed.

Clinical significance

This is the first study to investigate globe tenting and visual outcomes in pediatric patients with orbital cellulitis. In this small subset, there was no evidence of poor visual outcomes when surgical intervention was performed early. Whether or not earlier surgical intervention is warranted in patients with globe tenting is unclear and requires additional study.