Systemic Corticosteroids as an Adjunct Therapy in Pediatric Orbital Cellulitis: A Comprehensive Review and Meta-Analysis

By
Emily S. Acker
Gabriela Martin Gonzalez
Dylan Davie
Ratna B. Basak
April 20, 2026
0 min

Frontiers In Pediatrics

Overview

This systematic review and meta-analysis evaluated the use of adjunctive systemic corticosteroids in children hospitalized with orbital cellulitis. Findings indicate that corticosteroids do not significantly reduce hospital length of stay and may increase the risk of adverse outcomes such as surgical intervention and readmission.

Background

Orbital cellulitis is a serious infection in children that can lead to severe complications, including vision loss and intracranial issues. The role of adjunctive systemic corticosteroids in managing this condition is debated, as their anti-inflammatory properties may be counterbalanced by potential immunosuppressive effects. Understanding the efficacy and safety of corticosteroids in this context is crucial for optimizing pediatric care.

Data Highlights

Outcome	Effect of Corticosteroids	95% Confidence Interval
Length of Stay	Mean difference −0.43 days	−2.34 to 1.49
Surgery Risk	RR 2.08	1.47–2.96
PICU Admission Risk	RR 1.82	1.36–2.45
30-Day Readmission Risk	RR 2.53	1.94–3.29

Key Findings

Corticosteroids did not significantly reduce hospital length of stay in pediatric patients with orbital cellulitis.
Use of corticosteroids was associated with a higher risk of surgical intervention.
Corticosteroid treatment increased the likelihood of pediatric intensive care unit (PICU) admission.
There was a notable increase in the risk of 30-day readmission among patients receiving corticosteroids.
The certainty of evidence regarding these findings was assessed as low to moderate due to the observational nature of most studies.

Clinical Implications

Suggest alternative treatments or management strategies for pediatric orbital cellulitis.

Conclusion

The findings of this review suggest that adjunctive systemic corticosteroids do not provide meaningful benefits in pediatric orbital cellulitis and may pose additional risks. Further high-quality randomized controlled trials are necessary to clarify their role in treatment.