Author(s)
Amani Kais, MD
Patrick Sullivan, BS
Caroline Dundervill
Rafka Chaiban, MD, MHCM
John Nguyen, MD
Hassan Ramadan, MD, MSc
Chadi Makary, MD
Affiliation(s)
1 . Department of Otolaryngology, West Virginia University, Morgantown, WV2 . School of Medicine, West Virginia University, Morgantown, WV3 . Department of Pediatrics, West Virginia University, Morgantown, WV4 . Department of Ophthalmology, West Virginia University, Morgantown, WV;
Abstract:
Background: The standard of treatment for acute orbital infections include systemic and/or oral antibiotics.
Objective: To investigate the role of corticosteroid in the treatment for acute orbital infections.
Methods: Retrospective cohort study of patients presenting to the emergency department with acute orbital infections from 2012 to 2022. Patients’ comorbidities, treatment, hospital length of stay (LoS), and readmission were reviewed.
Results: 269 patients were reviewed. Mean age was 28 years (0-94), 50.9% were female. 36.8% had pre-septal cellulitis vs 63.2% had more advanced infections (orbital cellulitis or orbital abscesses), and 4.8% had neurological complications at presentation. 226 (84%) patients received antibiotics treatment alone vs 43 (16%) patients received both antibiotics and corticosteroid treatments.
There was no difference in age, diagnosis category, antibiotic treatment, and comorbidities between the two groups.
Median LoS for the steroid group was 4 days (IQR=5-1) vs 3 (IQR=5-2) in the non-steroid group, p=0.853. More patients in the non-steroid group presented with neurological complications (5.8% vs 0%, p=0.107), whereas more patients in the steroid group underwent surgical drainage (44.2% vs 22.6%, p=0.003). There was no difference in the 30-day readmission between the two groups (p=0.952). Multivariate linear regression of LoS showed association with neurological complications (Coef=19.5, p<0.0001) and surgical drainage (Coef=4.3, p<0.0001), but no association with corticosteroid use (Coef=-1.27, p=0.101). Similar results were obtained in the pediatric and adult populations.
Conclusions: The use of corticosteroid as adjunct treatment for acute orbital infections doesn’t seem to have an effect on outcome when adjusting for the severity of the infection.