Diagnostic Accuracy of different examinations in children with acute single sided orbital swelling

Acute single sided orbital swelling is a common clinical sign in the pediatric population. Differential diagnosis includes sinugen orbital complications along with several further diseases. The purpose of the present study was to evaluate the diagnostic significance of different examinations, particularly the inflammatory parameters (c-reactive protein, leucocytes, fever).

99 patients in a time period from 08/2019 through 09/2021 were evaluated. According to examination results patients could be grouped in 5 diagnostic groups as the cause for orbital swelling: sinugen (n=29), ophthalmogen (n=13), dentogen (n=4), trauma (n=20), and other causes (i.e. insect stiches; allergic reactions) (n=33). CRP values were significantly elevated in cases of sinugen complications (66.5mg/l, norm <5mg/l), whereas there was only a slight elevation in patients with dentogen (24.7mg/l), trauma (10.2mg/l) and other causes for orbital swelling (6.4ml/l). In orbital complications secondary to sinusitis which required surgery (n=15) CRP was 109.2mg/l in the average, in cases with conservative therapy 40.4mg/l. Over all patients, leucocytes were not elevated (12.11/ul), but in cases with sinugen cause they were slightly elevated (15.19/ul), which was statistically not significant.

Inflammatory parameters are only of limited value to elucidate the cause of an acute orbital swelling in children. However, in cases with sinugen orbital complications CRP values are elevated and in severe courses even higher than in courses which can be managed conservatively. Nevertheless, endoscopy of the nasal cavity and when indicated CT scans remain the gold-standard in the differential diagnosis of children with acute single sided orbital swelling.  

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Conflict of Interest

The author declares that there is no conflict of interest.

Publication History

Article published online:
24 May 2022