Orbital cellulitis is a sight threatening condition. It is unique as it is an infection of an organ covered by one specialty (ophthalmology) surgically managed by a second (otolaryngology) potentially under the care of a third (paediatrics).
This study analyses orbital cellulitis guidelines used by otolaryngologists across the UK.
51 acute admitting otolaryngology units across the UK were contacted via telephone for their orbital cellulitis guidance.
Twenty-three (45.1%) units confirmed having 24 guidelines for the treatment of orbital cellulitis. Eighteen (75%) protocols found were obtained from 17 trusts; 3 microbiology guidelines were obtained.
Twenty-one documents covering antibiotics were obtained, 11 (52.4%) routinely cover anaerobes during first line antibiotics.
Three (16.7%) protocols did not give imaging criteria; 2 (11.1%) recommend imaging all patients. The remaining 13 (72.2%) recommended imaging if there was neurology, orbital compression, inability to assess or no improvement after 48hours intravenous antibiotics. Four (22.2%) protocols specified contrast CT orbit and paranasal sinuses
Less than half of units contacted have available formal guidance for a sight threatening emergency. Only 52.4% advise first line anaerobe cover, despite its existence in 25% of surgical cultures. 22.2% of protocols specified contrast CT orbit and paranasal sinuses, the preferred first-line imaging investigation.
We highlight a lack of formal guidelines; and within existing guidelines areas for improvement in anaerobe cover and imaging. The evidence base for effective orbital cellulitis management is increasing and protocols need updating to minimise patient mortality and morbidity.