Objective: To investigate the clinical differences between adult and pediatric patients presenting with periorbital cellulitis secondary to acute rhinosinusitis (ARS).

Methods: Retrospective cohort study. Methods: Tertiary academic medical center. Methods: Patients presenting to the emergency department with acute periorbital cellulitis secondary to ARS from 2012 to 2022 were reviewed, to include past medical history, treatment, hospital length of stay (LoS), and readmission rates.

Results: About 163 patients were identified on chart review and included of which 80 were adults (age > 18). Mean age in the pediatric cohort was 6.4 (±4.6) years versus 49.2 (±18.5) years in the adult cohort. Both adults and children had similar computed tomography (CT) Lund-Mackay scores (9.2 vs 10.2, P = .191 respectively) and similar incidence of postseptal cellulitis (68.8% vs 65.1%, P = .617 respectively). The adult patients were more likely to require surgical treatment (45% vs 21.7%, P = .002), more likely to have neurological complications (11.3% vs 0%, P = .002), had longer hospital stay (LoS; 6.9 days vs 3.6 days, P = .002), and more likely to require readmission within 30 days (16.3% vs 6%, P = .037). Multivariate analyses showed that the adult population was independently associated with requiring surgical treatment (OR = 2.7, 95% CI = 1.3-6) but not with a longer hospital LoS (Coef 1.1, 95% CI = -0.5 to 2.7).

Conclusions: Adult patients presenting with acute periorbital cellulitis secondary to ARS are more likely to need surgical intervention and more likely to have longer hospital stay. Longer hospital stay in adult patients may be secondary to sequelae of the infection such as neurological complications.