Both orbital cellulitis (OC) and idiopathic/nonspecific orbital inflammation may result in pain, orbital congestion, and focal deficits. This study was a retrospective analysis of clinical findings and biomarkers used to distinguish between these conditions.
Study design
Records were reviewed of 49 patients diagnosed with bacterial OC or diffuse nonspecific orbital inflammation (DNSOI) at a single center in Australia between 2003 and 2021. White cell counts (WCCs) and/or C-reactive protein (CRP) levels were obtained at presentation, and the mean levels of these factors and the proportion of positivity were compared in the patients with OC and the patients with DNSOI.
Outcomes
The clinical findings were quite similar between the 2 groups, underscoring the inherent difficulty in making a diagnosis simply by interpreting examination features. However, the mean WCCs and CRP protein levels were significantly higher for patients with OC than for patients with DNSOI, and CRP levels were found to be more accurate at predicting OC, as normal WCCs may be found in patients with either condition.
Limitations
A retrospective study carries limitations, and the authors did not comment on previous interventions that these patients may have received prior to presentation. Often, patients with presumed cellulitis may try a course of oral antibiotics before oculoplastic surgeons see them, and that intervention may alter both WCCs and CRP values. CRP values may also be altered by associated medical conditions; while the authors documented some of these possible confounders, a retrospective study is prone to some elements of diagnostic difficulties.
Clinical significance
The distinction between OC and idiopathic orbital inflammation is a critical one. With an infectious process, early intervention with antibiotic agents is the standard of care, and delays in care that result from diagnostic confusion may lead to worse outcomes, including death. Often, the clinical presentation is not enough to make an accurate diagnosis. Simple lab tests may facilitate more prompt, accurate diagnosis and may help to guide initial treatment steps, thereby improving patient care.
Financial Disclosures: Dr. Edward Wladis discloses financial relationships with FuzeHub (Grant Support); Horizon Therapeutics (Consultant/Advisor and Lecture Fees/Speakers Bureau); Lions Eye Foundation (Grant Support); and has received patent royalties.