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

Monday, October 13, 2025

9:48 AM - 9:54 AM EDT

Location: 233-234

Disclosure(s):

Kimberly X. Wei, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Chau M. Phung, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Orbital cellulitis and orbital subperiosteal abscess are potentially vision-threatening complications of sinusitis. The role of systemic steroids in their management remains unclear. We sought to determine the safety and efficacy of systemic steroids for children with orbital complications of sinusitis.

Methods: Retrospective cohort study of children admitted for orbital cellulitis with or without subperiosteal abscess secondary to sinusitis at Children’s Hospital of Philadelphia over 6 years. 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 was used to control for potential confounders, including severity of disease as evidenced by proptosis and orbital abscess size on initial imaging study.

Results: Of 222 children admitted with orbital cellulitis (mean age 8.6 years), 26 (12%) received systemic steroids: 17 (65%) intravenous methylprednisolone or dexamethasone, 9 (35%) oral steroids; 16 (62%) 1 day of steroids, 10 (38%) 2 to 4 days of steroids. Children receiving steroids were more likely to present with proptosis (58% v. 37%, p=0.045) and an orbital abscess on CT (81% v. 69%, p=0.004). Steroid use was associated with a decrease in orbital or sinus surgery (19% vs 37%; OR=0.3, 95% CI: 0.1-0.9; p=0.03). There were no differences in length of stay (p=0.2), readmission (p=0.4), fungal infection (no cases), or vision loss (no cases) between the study groups.

Conclusions: Systemic steroid use in children with orbital complications of sinusitis 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 one day of steroids in our study; further research might evaluate the effects of longer steroid courses, as well as the subjective experience of children who have periocular swelling and pain from orbital cellulitis.

Presenting Author(s)

KW

Kimberly X. Wei, BS

Medical Student
Perelman School of Medicine At the University of Pennsylvania
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

AB

Adva Buzi, MD

The Childrens Hospital of Phildelphia, United States

Disclosure information not submitted.
Chau M. Phung, BA

Medical Student
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
YY

Yinxi Yu, MS

Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, United States

Disclosure information not submitted.
MR

Mark D. Rizzi, MD

Pediatric otolaryngologist
Childrens Hospital of Philadelphia Pediatric Otolaryngology
Lafayette Hill, PA, United States

Disclosure information not submitted.

Senior Author(s)

GB

Gil Binenbaum, MD

Children’s Hospital of Philadelphia, Pediatric Ophthalmology, United States

Disclosure information not submitted.