Role of oral corticosteroids in orbital cellulitis.

Abstract

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.

• Authors: Neelam Pushker, Lalit Kumar Tejwani, Mandeep S Bajaj, Saurbhi Khurana, Thirumurthy Velpandian, Mahesh Chandra
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 156 Issue 1 Pg. 178-183.e1 (Jul 2013) ISSN: 1879-1891 [Electronic] United States
• PMID: 23622565 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Glucocorticoids
• Metronidazole
• Vancomycin
• Ceftriaxone
• Prednisolone

Topics

• Administration, Oral
• Adolescent
• Adult
• Anti-Bacterial Agents (therapeutic use)
• Ceftriaxone (therapeutic use)
• Child
• Drug Therapy, Combination
• Eye Infections, Bacterial (drug therapy, microbiology)
• Eye Movements
• Female
• Glucocorticoids (administration & dosage, therapeutic use)
• Humans
• Infusions, Intravenous
• Male
• Metronidazole (therapeutic use)
• Middle Aged
• Orbital Cellulitis (drug therapy, microbiology)
• Prednisolone (administration & dosage, therapeutic use)
• Prospective Studies
• Single-Blind Method
• Vancomycin (therapeutic use)
• Young Adult