Periorbital cellulitis. Clinical and laboratory findings in 146 episodes, including tear countercurrent immunoelectrophoresis in 89 episodes.

Medical records of 144 children hospitalized for 146 episodes of periorbital cellulitis were reviewed. During 44 episodes, systemically administered antibiotics were given before hospitalization. Bacterial pathogens were isolated in only two (5%) of 44 episodes in pretreated patients compared with 33 (32%) of 102 episodes in patients who were not pretreated. Thirty-one children who were not pretreated were bacteremic. Compared with nonbacteremic children who were not pretreated, bacteremic children were younger, more often had a history of upper respiratory tract infection and fever, had a higher white blood cell count and temperature at admission, and more often had a violaceous cellulitis. No difference between groups existed in the frequency of a history of trauma or a local lesion near the affected eye. Tear specimens from 13 of 89 children tested by countercurrent immunoelectrophoresis (CIE) to detect Haemophilus influenzae type b capsular polysaccharide were positive. Compared with positive blood culture results, tear CIE has a sensitivity of 50% and a specificity of 93%. Streptococcus pneumoniae infections were not detected by CIE.