A Five Year Review of the Clinical Presentation and Management of Preseptal and Orbital Cellulitis in in-patients at Kenyatta National Hospital.

Abstract

Background: Preseptal cellulitis is a common eye condition especially in children and generally responds well to treatment. Orbital cellulitis is a more severe infection and has the potential risk of loss of sight and life. Prompt identification and treatment is necessary to minimize complications. The aim of the study is to assess local presenting features and outcomes of treatment, in order to improve care for these patients and optimize their outcomes. Study Objectives: To determine the demographic and clinical characteristics, treatment and outcomes of in-patients with preseptal and orbital cellulitis at Kenyatta national hospital from 1st January 2013- 31st December 2017. Methodology: Medical records of all patients admitted with a diagnosis of preseptal cellulitis, orbital cellulitis or lid abscess between 1st January 2013 and 31st December 2017 were retrospectively reviewed. Data collected was filled into a predesigned tool and analyzed using descriptive statistics. Results: Out of records of 67 patients, 20 had preseptal and 47 had orbital cellulitis. The male: female ratio was 7:3 in preseptal, and 2.1:1 in orbital cellulitis. Eighty percent of preseptal cellulitis patients were below 9 years while 45% of orbital cellulitis patients were in their second decade. Sinusitis was the commonest predisposing factor for orbital cellulitis, while upper respiratory tract infections were more common in preseptal cellulitis. Leucocytosis was found in 33% versus 44% of patients with preseptal and orbital cellulitis respectively. Microbiological yield was low as 58% cultured no growth. Overall, 54% required surgical intervention in addition to medical treatment due to abscess formation. Though vision improved for many, blindness (vision <3/60) was found in 11%. Conclusion: Preseptal and orbital cellulitis mostly affect children. Sinusitis being a common predisposing factor for both should be treated adequately to prevent complications. More microbiological investigations are required in these patients to better identify the local aetiological factors. Complications are not uncommon and include abscess formation, which often requires surgery. Patients with orbital cellulitis are at risk of visual loss and prompt treatment is required to avoid this.