• Written By:
    Oculoplastics/Orbit

    Investigators from a single tertiary eye center found that adding dexamethasone to initial antibiotic therapy may reduce hospital stay duration without inducing serious complications.

    Study Design

    This prospective, comparative interventional study included 43 children with orbital cellulitis. On admission, all patients were started on broad-spectrum IV antibiotics, with 28 (65%) also receiving IV dexamethasone (0.3 mg/kg/d every 6 hours for 3 days). The 15 (35%) whose parents did not consent to adjunct steroids served as the control group.

    Outcomes

    Overall, children who received IV steroids had significantly shorter hospital stays than those who did not receive steroids (3.8 vs. 6.7 days, P<0.001). This effect extended to steroid patients who underwent surgery compared with control patients who had surgery (5.0 vs. 7.3 days, P=0.011). There were few observed side effects from steroid treatment. All study patients returned to baseline health with no decrease in visual acuity. 

    Limitations

    The power of the study could be improved by having a larger sample. Also, since parents decided whether or not their child would receive steroids, more severe cases which would have necessitated a longer hospital stay irrespective of treatment may have received antibiotics alone. Lastly, treating physicians were not masked as to which children received steroids, and the decision to discharge may have been biased. 

    Clinical significance

    A randomized, double-blinded study is needed to further support these findings. However, this article and other literature do show that steroid use in cases of pediatric orbital cellulitis appears safe and likely reduces overall hospital stays. There is much less evidence for the use of steroids in adults with orbital cellulitis. Clinicians who care for children with orbital cellulitis may consider using steroids in addition to antibiotics on initial presentation.