Orbital Cellulitis Management in Pediatric and Adult Cohorts: A 12-Year Retrospective Analysis From a Tertiary Center

Orbital cellulitis (OC) is a vision-threatening infection requiring prompt medical and/or surgical intervention. This study evaluates clinical features, management outcomes, and predictors of surgical necessity in pediatric and adult OC patients.

Retrospective analysis of 40 OC patients (13 pediatric, 27 adult, ages: 34.8 ± 23.9 y) at Xi'an Fourth Hospital (2011-2023). The data collected and analyzed retrospectively including demographics, signs and symptoms, concomitant diagnoses, inpatient management, imaging results, surgical culture results, visual acuity at presentation and last follow-up, duration of intravenous antibiotic treatment, and sequelae of disease were collected.

Surgery was required in 84.6% (11/13) of pediatric and 88.9% (24/27) of adult patients. Staphylococcus aureus (17.1%), Staphylococcus epidermidis (11.4%), and MRSA (8.6%) predominated in cultures; 31.4% showed no growth. Ceftriaxone (45%) and cefotaxime (7.5%) were primary antibiotics. Surgical intervention significantly increased hospital costs (¥13,317 ± ¥5351 versus ¥1843 ± ¥509; P < 0.0001) but improved adult visual acuity (VA) from 0.5 ± 0.3 to 0.6 ± 0.4 ( P = 0.04). All patients achieved symptom resolution.

OC necessitates surgery in >80% of cases regardless of age, driven by abscess formation or medical failure. Staphylococcal species (including MRSA) are key pathogens, warranting tailored empiric therapy. Cost-effective management algorithms integrating Chandler staging and vaccine history are recommended.