Studies have suggested that the addition of corticosteroids in the management of periorbital and orbital cellulitis may be beneficial in regards to reducing swelling, pain, length of hospital stay (for those admitted) and surgical intervention. This study looks at this question further to better understand the benefits of corticosteroids in this diagnosis. One RCT was included in this meta analysis. The study divided subjects into two groups – one group received antibiotics alone and the other group received antibiotics plus corticosteroids (oral prednisolone). The study looked at outcomes such as length of hospital stay, use of IV antibiotics, pain, fever, periorbital edema, and extraocular movements. Patients that received corticosteroids in addition to antibiotics were in the hospital for an average of 14 days compared to 18 days for those that received antibiotics alone. The duration of IV antibiotics for those in the control group was 11 days compared to 8 for those receiving dual treatment. No evidence of significant pain reduction was found in the group that received corticosteroids, although they tended to have pain relief sooner than those receiving antibiotics alone. No difference in swelling was noted after 1 week amongst the two groups. Those that received corticosteroids tended to experience improved EOMs faster than those not receiving corticosteroids.
Based on these research findings, it seems that there are benefits to including corticosteroid treatment for periorbital and orbital cellulitis. However, there is concern for immune suppression with the use of corticosteroids and the data is not particularly convincing regarding the necessity of corticosteroids for these patients. Therefore, antibiotics remain the standard of care when treating these patients.