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Factors Point to Children at Risk of Intraorbital Abscess

Pain or difficulty with extraocular movement, proptosis associated with high risk of abscess

TUESDAY, March 9 (HealthDay News) -- In children with suspected cellulitis around the eye, factors associated with a high risk of intraorbital abscess include proptosis and/or pain or difficulty with movement in the extraocular area, according to research published online March 1 in Pediatrics.

Tiffany F. Rudloe, M.D., of the Children's Hospital Boston, and colleagues analyzed data from 918 patients who were admitted to a pediatric emergency department for suspected acute clinical periorbital or orbital cellulitis.

The authors note that, of this group, 298 underwent an orbital computed tomography (CT) scan, and 111 of these were found to have an abscess. According to a model that identified high-risk patients and a low-risk group, patients with proptosis, ophthalmoplegia, or pain with extraocular movement fell into the high-risk category. However, roughly half of patients with an abscess didn't have these symptoms.

"We present a tool for physicians who are considering emergent CT imaging versus antibiotic therapy and expectant management. In addition to the known high-risk findings of ophthalmoplegia and proptosis, or in the absence of these signs, we have shown that patients who have moderate-to-severe periorbital edema, or an absolute neutrophil count of greater than 10 000 cells per μL, also fall into a high-risk category and their evaluation should be expedited. We also suggest that those at low risk can be easily identified, and that CT imaging is of low yield for these patients," the authors conclude.

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