Ethmoiditis-associated periorbital cellulitis

Seventy-two children with periorbital cellulitis were followed prospectively during a 30-month study period. Twenty patients (28%) had mucopurulent rhinorrhea with obvious radiological ipsilateral opacity of the ethmoid sinuses. This group of patients, as opposed to patients with periorbital cellulitis and no associated ethmoiditis, is characterized by the following features: (1) Higher incidence of temperature > 38.5°C (16/20 vs 24/52. P < 0.01) and elevated white blood count > 15,000 cells/mm³ on admission (10/20 vs 5/52. P < 0.001). (2) Delayed recovery (6.7 ± 3.4 vs 3.4 ± 1.6 days. P < 0.001). (3) Higher rate of recurrent periorbital cellulitis with associated ethmoiditis within 6 months of follow-up (5/20 vs 1/52. P < 0.01). This ethmoiditis-associated serious form of periorbital cellulitis requires an aggressive treatment regimen and a prolonged follow-up.