The Role of Corticosteroids in the Management of Orbital Cellulitis: A Report by the American Academy of Ophthalmology.

Abstract

To review the literature on the benefits and risks of systemic corticosteroids in the setting of orbital cellulitis. A literature search was last performed in the PubMed database in August 2025. Articles were limited to original research in the English language that included at least 10 patients and specifically assessed outcomes in patients with orbital cellulitis who received systemic corticosteroids. The initial search yielded 104 articles; 9 articles were reviewed in full text and met all of the criteria for inclusion for this assessment. The panel methodologist assigned a level of evidence rating to each of the studies. One study was rated level I, 4 studies were rated level II, and 4 studies were rated level III. The studies included in this assessment used variable dosing patterns and durations of systemic corticosteroids. Some studies reported shorter lengths of hospitalization when these agents were used, but larger studies failed to replicate this benefit. Although patients who received corticosteroids experienced faster resolution of symptoms in the 2 studies that specifically assessed this metric, most studies reported equal rates of surgical intervention and hospital readmission among patients who did and did not receive it. Adverse events were rare and seemed to be self-limited at the doses used, although many studies did not specifically report these complications. The available evidence examining the effectiveness of systemic corticosteroids showed a lack of standardization, and many studies did not specifically report the rates of adverse events. Nevertheless, systemic corticosteroids may be safe in the setting of orbital cellulitis and may improve the rate of symptom resolution. The impact of corticosteroids on duration of hospitalization remains unclear. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.