Orbital Osteomyelitis in the Pediatric Patient

Orbital osteomyelitis in the pediatric patient is a rare clinical entity with limited reports in the literature. Outcomes for orbital osteomyelitis can be potentially fatal, and effective diagnosis and treatment often requires an extensive differential and multidisciplinary team approach. As such, the authors systematically evaluated a pooled analysis of patients in published studies to better understand the clinical trends of this condition. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement guidelines, the authors queried the PubMed, Cochrane Library, and ISI Web of Science databases. A total of 23 patients (47.8% males) participated in 10 studies between 1977 and 2017. Average age of included patients was 7.3 ± 5.3 years old with follow-up of 8.7 ± 9.8 months. Over half of the patients present with fistula (65.2%) and/or fever (43.5%). Sequestrum formation was common (52.2%) but only seen in chronic osteomyelitis patients. The most frequently infected orbital bone was the frontal bone (n = 10, 43.5%). Nearly all patients were cultured (82.6%) and received imaging, such as computerized tomography (43.5%) or X-ray (47.8%). Streptococcus pyogenes was the most common organism isolated (21.7%), while trauma was the most common source of infection (26.1%). Most patients were treated successfully with combined surgical debridement and antibiotics (73.9%). Significant differences between acute and chronic orbital osteomyelitis patients include clinical presentation, use of magnetic resonance imaging, methicillin-resistant Staphylococcus aureus infection, and procedure only treatments. The studies reviewed here provide a comprehensive overview of the clinical presentation, infection sources, diagnostic modalities, common organisms, and treatment options involved in pediatric orbital osteomyelitis.