FIGURE 123.5 CT scan of a child with right-sided orbital cellulitis demonstrating retro-orbital inflammation and a subperiosteal abscess Diagnostic Testing Imaging is not routinely indicated in periorbital cellulitis In patients with concern for orbital cellulitis, CT or MRI scanning is used to confirm the diagnosis and detect its complications including subperiosteal abscess, orbital abscess, cavernous sinus thrombosis, and/or brain abscess An MRI spares the patient radiation exposure and can readily identify orbital disease that can mimic orbital cellulitis such as tumor, hemorrhage, or inflammatory pseudotumor CT imaging however is cheaper, more readily available, less likely to require sedation, and affords excellent views of the bony orbital wall ( Fig 123.5 ) Contrast-enhanced imaging should generally be expedited in all cases with highrisk features including limitation or pain with eye movements, vision loss, proptosis, signs of CNS involvement, inability to perform a reliable examination, and cases of presumed periorbital cellulitis which not improve on IV antibiotics within 48 hours Management and Disposition In otherwise well children who are beyond infancy and have mild periorbital cellulitis and no systemic signs or symptoms, oral antibiotics are appropriate The prognosis for complete recovery without complications is excellent The patient should be reevaluated within 24 to 48 hours to ensure improvement If no improvement occurs, the patient should then be admitted for IV antibiotics