SPECIFIC ASPECTS OF COMPLEX TREATMENT FOR ACUTE ORBITAL CELLULITIS IN CHILDREN (Clinical Case)

Orbital cellulitis represents an urgent challenge in ophthalmology, particularly in pediatric practice. An individualized approach to each patient is essential due to the severity of potential complications and treatment-related sequelae. Strict adherence to therapeutic protocols is critical during both the acute phase and long-term follow-up. This report presents a clinical case of acute orbital cellulitis in a child, managed with adjunctive intravenous immunoglobulin (IVIG) as part of complex surgical and medical treatment. While immune modulation during active infection remains debated, IVIG administration in this case proved clinically justified and pivotal. Results and their discussion. A 1-year, 8-month-old male was admitted to the City Children’s Clinical Hospital for 16 days with a diagnosis of acute orbital cellulitis. On examination, the child was in severe condition, exhibiting marked pain, hyperthermia, and tense solid edema of both upper and lower eyelids. The eyelids were cyanotic, hyperthermic on palpation, with minimal serous discharge and blepharospasm. Eyelid opening could not be achieved without anesthetic and sedative assistance. Complete examination of the globe and posterior segment structures remained unfeasible under these conditions. Additional instrumental and laboratory studies were performed, which confirmed the diagnosis. The patient underwent multidisciplinary consultations with specialists in neurology, otolaryngology, dentistry, maxillofacial surgery, and pediatrics. Concurrent diagnoses included acute sinusitis and rhinitis. No contributory allergological, genetic, or epidemiological risk factors were identified. The treatment regimen consisted of antibacterial therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, and symptomatic management. However, the child’s general condition remained severe during the first 72 hours of treatment, with no clinical improvement observed. On day 4 of hospitalization, surgical orbital drainage was performed, yielding serous exudate, and antibiotic therapy was escalated, yet the condition remained refractory. Therefore, on day 9, immunoglobulin was administered in three doses as an adjunct to the ongoing treatment. Within 24 hours, the child demonstrated resolution of fever, reduction in periorbital edema and inflammation, and normalization of inflammatory markers. By day 16 of hospitalization, the patient was discharged in satisfactory condition. Conclusions. 1. The use of immunoglobulin in the complex treatment of acute orbital cellulitis in children appears clinically justified, as it contributed to rapid clinical improvement in this refractory case. 2. The development of standardized treatment protocols incorporating immunoglobulin therapy may improve prognostic outcomes in similar cases. 3. Further research is required to elucidate the precise immunomodulatory mechanisms of immunoglobulin in the treatment of acute orbital cellulitis in pediatric patients