Indicators for imaging in periorbital cellulitis secondary to rhinosinusitis

Basel Jabarin, Ephraim Eviatar, Ofer Israel, Tal Marom, Haim Gavriel

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Purpose: Our objective was to identify the clinical indicators for subperiosteal orbital abscess (SPOA) among patients who present with periorbital cellulitis secondary to rhinosinusitis, and to evaluate the need for performing a computerized tomography (CT) scan. Methods: A retrospective cohort study of all patients admitted to our tertiary care emergency department between 2006 and 2014 was conducted. Included were healthy patients with acute periorbital cellulitis secondary to rhinosinusitis. Variables analyzed included age, gender, duration of symptoms, previous antibiotic therapy, highest recorded temperature, physical examination findings, ophthalmologist’s examination results, laboratory results, and interpretation of imaging studies, when performed. Results: Of the 123 identified patients, 78 (63%) were males, with a mean age of 4 years (range 1–70). 68 patients were categorized as Chandler’s 1 disease, 2 as Chandler’s 2, and 53 as Chandler’s 3. 68 patients underwent a CT scan, of those 53 had SPOA. Proptosis and ophthalmoplegia were strongly associated with the presence of an abscess (P OpenSPiltSPi 0.001). However, 14 patients with no ophthalmoplegia or proptosis who underwent a CT scan were older (mean age, 10 years; P OpenSPiltSPi 0.028), and had higher neutrophil count of 78 versus 59% (P = 0.01). This group of patients had a clinically rapidly progressive disease, receiving wider broad-spectrum antibiotics or had their antibiotic treatment replaced to broader spectrum antibiotics through their course of treatment (48.2% compared to only 6.1%). Conclusions: We confirmed that patients with proptosis and/or limitation of extraocular movements are at high risk for developing SPOA, yet many do not have these predictors. Other features can identify patients who do not have proptosis and/or limitation of extraocular movements but do have significant risk of SPOA, and in these cases performing an imaging study is strongly suggested.

Original languageEnglish
Pages (from-to)943-948
Number of pages6
JournalEuropean Archives of Oto-Rhino-Laryngology
Issue number4
StatePublished - 1 Apr 2018
Externally publishedYes


  • Acute rhinosinusitis
  • Computerized tomography
  • Orbital complication
  • Subperiosteal orbital abscess


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