Preseptal or Orbital Cellulitis Clinical Pathway, All Settings – Considerations for Surgical Management

Preseptal or Orbital Cellulitis Clinical Pathway — All Settings

Considerations for Surgical Management

In the case of isolated orbital disease, the decision to intervene surgically is made by the attending orbital surgeon.

In the case of concurrent orbital and sinus disease, the decisions of surgical intervention and which surgical services (orbital, ENT) will operate and require an attending-to-attending level discussion between the orbital and ENT surgeons prior to the child going to the OR.

Review the guidelines below. The decision to operate is made by the attending surgeon(s) based on the clinical findings of the individual. Note that size of abscess and age of child are not absolute indications for surgery.
Strongly Consider Surgery
  • Evidence of optic neuropathy (e.g., decrease in visual acuity, RAPD, color vision loss)
  • Elevated intraocular pressure above 35 mmHg based upon reliable measurement
  • Excessive proptosis possibly stretching optic nerve
  • Progression on maximum medical therapy
  • Concern for rapid progression
Consider Surgery
  • Proptosis
  • Large subperiosteal abscess (SPA)
  • Limited ocular motility
  • Failure to respond to medical treatment