Safety and Efficacy of Systemic Corticosteroids in Children With Orbital Complications of Acute Sinusitis.

Abstract

To determine the safety and efficacy of systemic steroids for children with orbital complications of sinusitis. Retrospective cohort study. Tertiary children's hospital, January 2017 to June 2023. Hospitalized children were classified by whether they received systemic corticosteroids, in addition to systemic antibiotics, prior to any surgery. Primary outcomes were length of admission, need for orbital/sinus surgery, readmission, vision loss, and fungal infection. Multivariable regression controlled for potential confounders, including severity of disease on initial imaging study. Of 222 children with orbital cellulitis (mean age 8.6 years), 26 (12%) received steroids: 17 (65%) intravenous methylprednisolone or dexamethasone, 9 (35%) oral steroids; 16 (62%) 1 day and 10 (38%) 2 to 4 days of steroids. Children receiving steroids more often had proptosis (58% vs 37%, P = .045) and orbital abscess on CT (81% vs 69%, P = .004). Steroid use was associated with decreased orbital or sinus surgery (19% vs 37%; OR = 0.3, 95% CI: 0.1-0.9; P = .03). There were no differences in length of stay (P = .2), readmission (P = .4), or vision loss (no cases) between the study groups or fungal or secondary infection (no cases). Systemic steroid use in children with orbital cellulitis was not associated with adverse outcomes, such as vision loss or readmission, and may offer potential benefits, including avoidance of surgery in some cases. A majority received only 1 day of steroids in our study; further research might evaluate the effects of longer courses and the subjective experience of children who have periocular swelling and pain.