Orbital Imaging and Vision Loss-Child orbital pressure, retinal artery/superior ophthalmic vein occlusion, optic nerve injury (leading to vision loss), cavernous sinus thrombosis, or empyema [46]. Clinical findings alone may not be specific enough to distinguish preseptal from orbital infections or those with complications. Proptosis and limitation of the extraocular movements are indicators of postseptal inflammation, but these are not very accurate and fail to differentiate postseptal inflammation from abscess [44]. Other risk factors for postseptal inflammation are high neutrophil count, the absence of infectious conjunctivitis, gross periorbital edema, age >3 years, and previous antibiotic therapy [44]. The primary role of imaging is to differentiate preseptal cellulitis from postseptal cellulitis and abscess. It also helps in identifying underlying sinusitis and intracranial complications of orbital infections. CT Head There is no relevant literature to support the use of CT head as the initial evaluation of children with suspected periorbital or orbital infection. CT head with IV contrast may be considered in cases in which intracranial complications of the orbital cellulitis (like subdural empyema or cavernous sinus thrombosis) are suspected [46]. Precontrast imaging is typically not necessary in evaluating these patients because they do not add significant diagnostic information in this scenario. CT Orbits CT of the orbits with IV contrast is considered the most useful imaging in cases of suspected orbital infection [46]. It aids in differentiation of preseptal cellulitis from postseptal cellulitis and abscess. It is also useful in detection of complications like superior ophthalmic vein/cavernous sinus thrombosis or subdural empyema [46]. Precontrast imaging is typically not necessary in evaluating these patients because they do not add significant diagnostic information in this scenario.
Orbital Imaging and Vision Loss Child. Orbital Imaging and Vision Loss-Child orbital pressure, retinal artery/superior ophthalmic vein occlusion, optic nerve injury (leading to vision loss), cavernous sinus thrombosis, or empyema [46]. Clinical findings alone may not be specific enough to distinguish preseptal from orbital infections or those with complications. Proptosis and limitation of the extraocular movements are indicators of postseptal inflammation, but these are not very accurate and fail to differentiate postseptal inflammation from abscess [44]. Other risk factors for postseptal inflammation are high neutrophil count, the absence of infectious conjunctivitis, gross periorbital edema, age >3 years, and previous antibiotic therapy [44]. The primary role of imaging is to differentiate preseptal cellulitis from postseptal cellulitis and abscess. It also helps in identifying underlying sinusitis and intracranial complications of orbital infections. CT Head There is no relevant literature to support the use of CT head as the initial evaluation of children with suspected periorbital or orbital infection. CT head with IV contrast may be considered in cases in which intracranial complications of the orbital cellulitis (like subdural empyema or cavernous sinus thrombosis) are suspected [46]. Precontrast imaging is typically not necessary in evaluating these patients because they do not add significant diagnostic information in this scenario. CT Orbits CT of the orbits with IV contrast is considered the most useful imaging in cases of suspected orbital infection [46]. It aids in differentiation of preseptal cellulitis from postseptal cellulitis and abscess. It is also useful in detection of complications like superior ophthalmic vein/cavernous sinus thrombosis or subdural empyema [46]. Precontrast imaging is typically not necessary in evaluating these patients because they do not add significant diagnostic information in this scenario.