Trends of Sinusitis-Associated Orbital Cellulitis in Pediatric Patients: A Retrospective Cohort Review

TL;DR

This study examines patterns of orbital cellulitis in children linked to sinusitis, finding that it often occurs with chronic sinusitis and is most common in winter and spring.

Contribution

The study identifies seasonal trends and sinus involvement patterns in pediatric sinusitis-associated orbital cellulitis.

Findings

Orbital cellulitis in children is most commonly associated with chronic rhinosinusitis.

The ethmoid sinus is most frequently involved in cases of single sinus sinusitis.

Most cases of orbital cellulitis involve two or more sinuses.

Abstract

Background and objective

Orbital cellulitis is mostly associated with sinusitis. The pediatric cases have a peculiar clinical presentation and variability with respect to different factors like season, type of sinus involved, and number of sinuses involved. In this study, we aimed to analyze the trends of sinusitis-associated orbital cellulitis in pediatric patients, which, we believe, would help physicians in managing these patients.

Material and methods

We retrospectively reviewed the discharge records of 74 pediatric patients treated at the ENT-Head and Neck Surgery Department of the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, between January 2015 and March 2025. The study included only inpatients aged 1-14 years who were diagnosed with orbital cellulitis secondary to associated sinusitis, confirmed by CT findings. Data on patients’ demographics, clinical characteristics, month of presentation, type of sinusitis, and sinuses involved were recorded. Trends in the form of results were presented in tables and figures.

Results

The mean age of the cohort was 7 ± 4.3 years, with 47 (63.51%) being male and 27 (36.49%) female. Out of all the cases admitted, 70 (94.6%) had fever at the time of presentation, 74 (100%) had headache, 74 (100%) had pain, and 74 (100%) had chemosis and periorbital edema. Of the patients, 41 (55.40%) had ophthalmoplegia, 29 (39.19%) had facial edema, and 14 (18.92%) had reduced eyesight. There were 49 (66.22%) known cases of chronic sinusitis. Of the total number of cases, 29 (39.19%) occurred in the winter, 18 (24.32%) in the spring, 17 (22.97%) in the summer, and 10 (13.51%) in the fall. Of the total cases, 23 (31.08%) involved a single sinus, 46 (62.16%) involved two or more sinuses, and five (6.76%) involved pansinusitis. In cases with single sinus sinusitis, the ethmoid was most frequently involved (72.4%).

Conclusions

We observed that cases of sinusitis-associated orbital cellulitis had a peculiar presentation including headache, discomfort, chemosis, periorbital pain, and fever. Orbital cellulitis was more frequently linked to chronic rhinosinusitis. Orbital cellulitis linked to sinusitis peaked in the winter and spring. The most frequent cause of orbital cellulitis in children was ethmoidal sinusitis. Orbital cellulitis was typically caused by sinusitis involving two or more sinuses.

Figures