Role of Oral Corticosteroids in Orbital Cellulitis

• Published in: American journal of ophthalmology 2013-07, Vol.156 (1), p.178-183.e1
• Main Authors: Pushker, Neelam, Tejwani, Lalit Kumar, Bajaj, Mandeep S, Khurana, Saurbhi, Velpandian, Thirumurthy, Chandra, Mahesh
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents - therapeutic use; Ceftriaxone - therapeutic use; Cell adhesion & migration; Child; Drug Therapy, Combination; Eye Infections, Bacterial - drug therapy; Eye Infections, Bacterial - microbiology; Eye Movements; Female; Glucocorticoids - administration & dosage; Glucocorticoids - therapeutic use; Humans; Infections; Infusions, Intravenous; Male; Metronidazole - therapeutic use; Middle Aged; Motility; Ophthalmology; Orbital Cellulitis - drug therapy; Orbital Cellulitis - microbiology; Pain; Patients; Prednisolone - administration & dosage; Prednisolone - therapeutic use; Prospective Studies; Single-Blind Method; Vancomycin - therapeutic use; Young Adult
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2013.01.031

Purpose To evaluate the role of oral corticosteroids as an anti-inflammatory adjunct in the treatment of orbital cellulitis. Design Prospective, comparative, single-masked, interventional clinical study. Methods setting : Tertiary eye care center (All India Institute of Medical Sciences). study population : Patients with acute onset (within 14 days) of orbital cellulitis with or without abscess. intervention : Patients were randomized into 2 groups in the ratio of 1:2. Both groups received initial intravenous antibiotics. In Group 2, oral steroids were added after an initial response to intravenous antibiotics. main outcome measures : Resolution of signs and symptoms, duration of intravenous antibiotics, length of hospital stay, and sequelae of disease (ptosis, proptosis, and movement restriction) were evaluated and compared between the 2 groups. Results A total of 21 patients (age range, 11-59 years) with orbital cellulitis were studied. There were 7 patients in Group 1, who received standard intravenous antibiotics, and 14 in Group 2, who received adjuvant steroids. Patients in Group 2 showed an earlier resolution of inflammation in terms of periorbital edema ( P  = .002 at day 7), conjunctival chemosis ( P < .001 at day 10), and pain ( P  = .012 at day 7). They also attained vision of 0.02 on logMAR earlier than Group 1 patients. Decrease in proptosis and improvement in extraocular movements were also significantly better with the use of steroids ( P  = .027 at day 10, P  = .003 at day 14, respectively). While a significant number of patients in Group 1 had mild residual ptosis, proptosis, and movement restriction at 12 weeks, none of the patients treated with steroids had any residual changes ( P  = .023, P = .001, and P  = .001, respectively). The durations of intravenous antibiotics and hospital stay were significantly less in Group 2. Conclusion Use of oral steroids as an adjunct to intravenous antibiotic therapy for orbital cellulitis may hasten resolution of inflammation with a low risk of exacerbating infection.