To determine the appropriate early management of orbital cellulitis and the
current bacterial etiology and to evaluate the clinical usefulness of orbi
tal computed tomographic imaging for this infection, a prospective study of
orbital cellulitis was conducted during a 2-year period, 1999 to 2000, aft
er the introduction of a conservative medical management plan designed by o
ur pediatric infectious diseases, ophthalmology and otolaryngology services
. Basically patients did not have surgical intervention unless progressive
involvement of the optic nerve occurred after 24 to 36 h of intravenous ant
imicrobial therapy. Nine patients had orbital cellulitis and subperiosteal
abscesses; only one required surgical drainage because of progressive disea
se, this case being culture-negative. One had a blood culture positive for
Streptococcus pneumoniae; conjunctival cultures showed moderate to heavy gr
owth for S. pneumoniae from this and two other patients, but otherwise bact
erial etiology could not be defined. Haemophilus influenzae was not recover
ed from any of their blood or conjunctival cultures. This experience, durin
g the computed tomography scan and Haemophilus vaccine era, supports an ini
tial medical management approach for most patients with subperiosteal or re
trobulbar abscesses resulting in orbital cellulitis.