Study Rethinks Clinical Signs of Orbital Cellulitis

An investigation advocates for using only 4 clinical signs as indicators of orbital imaging in children with periorbital swelling.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 Fall Scientific Symposium of the American Society of Ophthalmic Plastic and Reconstructive Surgery, held in New Orleans from November 11 to 12, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the oculoplastic researchers and other clinicians at the ASOPRS. Check back for more from the ASOPRS 2021 Fall Scientific Symposium.

Researchers presenting at the American Society of Ophthalmic Plastic & Reconstructive Surgery 2021 Annual Meeting, sought to evaluate clinical signs predictive of orbital cellulitis in children with eyelid swelling to guide decision making for orbital imaging. 

In a single center, retrospective cohort study spanning 8 years, researchers looked at children with periorbital swelling with a concern for preseptal or orbital cellulitis. All patients in the study were examined by an ophthalmologist who evaluated clinical signs based on orbital imaging including conjunctival injection, moderate to severe conjunctival chemosis, limitation of extraocular motility, proptosis, change in vision, relative afferent pupillary defect (rAPD), and optic disc changes, such as swelling or pallor, and temperature greater than 100.4˚ F. 

A total of 373 children were included in the study (mean age of 6.8 years, 230 boys, 142 with nonorbital cellulitis, 231 with orbital cellulitis). In children with periorbital swelling, presence of 1 or more of the following clinical signs were predictive of orbital cellulitis: motility limitation, proptosis, moderate-severe chemosis, or temperature hotter than 100.4˚ within 24 hours of presentation. 

Orbital imaging yielded a 76% sensitivity (95% CI 70%-81%) and a 76% specificity (95% CI 69%-83%) for orbital cellulitis. This suggests that consideration of only 4 clinical signs as an indication for orbital imaging in children with periorbital swelling yields higher sensitivity and specificity than conventional orbital signs and published decision-making algorithms. Optic nerve abnormality and rAPD, while highly specific, are rare and cannot be relied on in most instances, researchers reported. Additionally, researchers concluded that conjunctival injection or change in vision as predictive signs are neither sensitive nor specific for orbital cellulitis. 

Visit Ophthalmology Advisor’s conference section for complete coverage of the ASOPRS 2021 Fall Scientific Symposium.



Lin L, Schein Y, Revere K, et al. Re-evaluating Clinical Signs of Orbital Cellulitis. Poster Presented at: American Society of Ophthalmic Plastic & Reconstructive Surgery 2021 Annual Meeting; November 12-15, 2021; New Orleans, LA.