SEP 19, 2013
This prospective, randomized study found that adjunctive oral steroids can hasten resolution of inflammation in acute bacterial orbital cellulitis with a low risk of exacerbating infection. Though complete resolution of infection was seen in all patients, the addition of steroids helped in early resolution of inflammation and improved the overall outcome.
Subjects were 21 patients with acute bacterial orbital cellulitis randomized to standard intravenous antibiotics with or without adjuvant steroids after initial positive response to antibiotics.
Patients who received steroids showed an earlier resolution of inflammation in terms of periorbital edema (P = 0.002 at day seven), conjunctival chemosis (P < 0.001 at day 10) and pain (P = 0.012 at day seven). They also attained vision of 0.02 logMAR earlier than patients who didn’t receive steroids. Decrease in proptosis and improvement in extraocular movements were also significantly better with the use of steroids.
Although a significant number of patients in the steroid group had mild residual ptosis, proptosis and movement restriction at 12 weeks, none of them had any residual changes. Also the duration of intravenous antibiotics and hospital stay were significantly less in the steroid group.
The authors write that there are several unresolved issues related to the use of corticosteroids in orbital cellulitis, including timing and duration, whether they should be added with the first dose of antibiotics, their use in younger children, and whether they are beneficial in patients who do not respond to antibiotics.