Orbital cellulitis is an uncommon condition that previously was associated with severe complications. It is classified as pre-septal cellulitis and postseptal cellulitis based on the anatomical landmark, the orbital septum (Fig 1). Differentiation between the two, prompt diagnosis and early management are essential when these conditions are suspected, to avoid potentially catastrophic sequelae including loss of vision and intracranial complications such as venous thrombosis and empyema. Pre-septal cellulitis and post-septal cellulitis can be difficult to differentiate clinically and, therefore, imaging is often required for confirmation...

This was a retrospective study of patients who had CT scans of their orbits for suspected preseptal and orbital cellulitis. All patients underwent post -contrast head and orbits scan with multiplanar reformats. The CT protocols were analysed with regard to views obtained (axial, coronal and sagittal), the use of image reformats, and whether the brain was scanned. Axial and coronal scans of the orbits and paranasal sinuses were obtained at 1.6-mm intervals both before and after intravenous injection of contrast material.

Sixteen patients with preseptal and orbital cellulitis were identified. The mean age was 8 years with no sex preponderance. Preseptal cellulitis was diagnosed in 5 cases (Figure 2) and orbital cellulitis for the remaining. Fourteen patients had paranasal sinus disease. Three major types of CT changes were observed in orbital cellulitis: diffuse fat infiltration, subperiosteal abscess and orbital abscess. Diffuse fat infiltration (characterized by an increased density of the extra- or intraconal fat) was seen in 11 patients (Figure 3). A subperiosteal abscess was diagnosed...

Orbital infection can be a commonly encountered entity. It is important to differentiate between preseptal cellulitis which is limited to the soft tissues anterior to the orbital septum often managed with oral antibiotics, and orbital cellulitis which is extended posterior to theorbital septum,more serious condition requiring hospitalisation and parental antibiotics. It can derive from multiple causes such as dental abscess, trauma, closed fractures, periocular surgery, panophthalmitis, septicemia and immunosuppression, but in the vast majority of cases they represent complications of sinusitis. In our study, we...

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