Author’s Disclosure Block: Judy Gaffar, none; Jenna Kliot, none; Catherine Achim, none; Justine Rheault, none; Rosanne Superstein, none

Abstract Body
Purpose: Orbital cellulitis in children usually follows paranasal sinus infections, posing significant risk to visual function and the potential for intracranial complications and mortality. However, there is currently a lack of comprehensive literature on the management and outcomes of pediatric orbital cellulitis, leading to variability in treatment approaches. This study aims to assess the epidemiology, treatments, and ophthalmological outcomes in pediatric patients with orbital cellulitis. Study Design: Retrospective chart review of patients diagnosed with orbital cellulitis and evaluated by the ophthalmology service at a pediatric tertiary care hospital in 2022 and 2023. Methods: Medical records of all patients hospitalized for orbital cellulitis over two years were reviewed. Key outcomes included hospitalization duration, need for surgical intervention, microbial culture results, and ocular complications. Demographic data, clinical history, imaging, and ophthalmological assessments were documented. Results: Over two years, the ophthalmology service evaluated 64 patients with orbital cellulitis; 37 were male (57.81%) and the mean age was 7.68 years (range 1-14.7 years). All but one had radiographic evidence of sinusitis (98.44%), and all required hospitalization for a mean duration of 7.8 days (range 2-30 days). Two patients (3.13%) had bacteremia, and all received intravenous antibiotics. The average treatment duration was 24 days, with 12 days on intravenous and 13 days on oral antibiotics. Sixteen patients (25%) were discharged home on intravenous antibiotics, for a mean duration of 18.8 days of intravenous treatment. Four patients (6.25%) received systemic corticosteroids.Surgical intervention was required in 27 patients (42.19%), including sinus drainage (25 patients, 39.06%), orbital abscess drainage (26 patients, 40.63%), and intracranial abscess drainage (1 patient, 1.56%). All had intraoperative cultures sent, with 20 cultures (74.04%) yielding positive results, most commonly group A streptococcus (18 cases, 90%). Four patients (6.25%) had intracranial complications. Surgical intervention occurred an average of 2.5 days after abscess identification on CT.Extraocular movement abnormalities were the most common ophthalmological finding (49 patients, 77%), followed by proptosis (20 patients, 31%), conjunctival erythema (19 patients, 30%), and chemosis (12 patients, 18.75%). No cases of optic neuropathy were reported. Conclusion: Orbital cellulitis in the pediatric population can be safely managed with broad-spectrum, intravenous antibiotics, prompt hospitalization and surgical drainage of abscesses. Although no cases of optic neuropathy were observed, the high incidence of ocular findings supports routine ophthalmological evaluation. Despite timely treatment, intracranial involvement may still occur, highlighting the importance of re-imaging in patients with clinical deterioration.