Orbital infections predominantly affect the paediatric population and complications can be very serious. The cellulitis can be preseptal or orbital and the abscess can be confined within the periosteum or extend into the orbit. Cavernous sinus thrombosis can complicate the condition. The purpose of this study was to review the practice of management of orbital infections at a tertiary referral centre, compare it with the management described in the literature and establish guidelines for safe management. In the retrospective review of management of 54 children at a tertiary centre over a four year period and in the 17 articles reviewed from the literature, there were wide variations in practice. There seemed to be no fixed pattern for a multidisciplinary approach with ophthalmologists, radiologists and microbiologists. There were wide variations in use of culture and sensitivity to picking up infecting organisms which over time have changed from haemophilis influenzae to strains of streptococcus, staphylococcus and MRSA. CT scans, done in half of patients, did not necessarily follow from high risk indications. Based on these findings, a definitive protocol has been established which appears to be logical and is followed widely. Aspects which the protocol clarifies include the immediate need for ophthalmology review, obtaining cultures from blood, conjunctiva and nose, prompt intravenous antibiotics, topical nasal steroids and close monitoring with regard to vision. The need for immediate CT scans and discussion with a microbiologist has been established. The article offers helpful guidance, applicable at all centres, to avoid serious complications of this condition.

Orbital infections: five year case series, literature review and guideline development.
Atfeh MS, Khalil HS.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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