9 Corticosteroid use in periorbital and orbital cellulitis: A Cochrane systematic review
Bibliographic record
Abstract
Abstract Background There is significant variation in the use of corticosteroids for the treatment of periorbital and orbital cellulitis. Corticosteroids may act to reduce inflammation and edema but there are concerns that corticosteroids may lead to immune suppression and worsening infection. Evidence-based recommendations regarding the use of corticosteroids for periorbital and orbital cellulitis are lacking. Objectives To assess the effectiveness and safety of corticosteroids in the treatment of periorbital and orbital cellulitis. Design/Methods We conducted a detailed search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL Plus, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform for randomized controlled trials (RCTs) of children and adults with periorbital and orbital cellulitis treated with systemic or intranasal corticosteroids. There were no exclusions based on language or publication status. Studies were excluded if they focused exclusively on participants undergoing elective surgery, on post-operative infections, or infections secondary to trauma. Two reviewers independently assessed studies for inclusion, and extracted data in duplicate. Risk of bias was assessed using the Cochrane Collaboration’s domain-based evaluation tool. Data were analyzed according to standard Cochrane methodology. Results Of the 7,476 unique results identified, 7,465 records were excluded based on title and abstract screening, and a further 10 records were excluded based on full text review. We identified one small RCT conducted in India with an unclear risk of bias. No other eligible ongoing or completed trials were identified. The small trial of 21 participants 10 years and older compared the use of corticosteroids and antibiotics (n=14), to the use of antibiotics alone for the treatment of orbital cellulitis (n=7). Participants receiving corticosteroids had a shorter length of hospital stay (14.1 ±3.7 vs. 18.4 ±5.9 days, p=0.02) and required antibiotics for a shorter duration (8.6 ±1.3 vs. 11.6 ±4.6 days, p=0.013) compared with the control group. Earlier improvements in fever, pain, periorbital edema, extra ocular motility, conjunctival chemosis, and visual acuity were seen in the corticosteroid group. No major complications of orbital cellulitis or adverse effects of corticosteroids were reported. Conclusion There is insufficient evidence to draw conclusions about the use of corticosteroids in the treatment of periorbital and orbital cellulitis. Currently, there is significant variation in how corticosteroids are used in clinical practice and additional high-quality evidence is needed to inform decision making.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.013 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.010 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".