Abstract Listings 2026

Purpose

Orbital and pre-septal cellulitis are potentially sight- and life-threatening infections requiring prompt diagnosis and treatment. This audit evaluated adherence to local antimicrobial and imaging guidelines in adult and paediatric patients presenting to a UK ophthalmology service.

Methods

A retrospective review was performed of all patients diagnosed with orbital or pre-septal cellulitis between January 2024-2025. Electronic records were reviewed for antimicrobial management, treatment duration, CT imaging, follow-up, and adverse outcomes.

Results

79 patients were identified, including 2 adults with orbital cellulitis and 77 patients with pre-septal cellulitis (54 adults, 23 paediatric). Both orbital cellulitis patients underwent same-day CT imaging and received guideline-compliant intravenous ceftriaxone, flucloxacillin, and metronidazole, followed by oral co-amoxiclav with or without metronidazole. Total treatment duration remained guideline-compliant. No visual loss, ICU admission, or mortality occurred. Among adults with pre-septal cellulitis, 49 of 54 (91%) were managed initially with oral antibiotics and 5 of 54 (9%) received intravenous therapy, usually ceftriaxone, flucloxacillin, and metronidazole combinations. Oral co-amoxiclav was mostly used (45%), followed by flucloxacillin (39%) and clindamycin (12%). Antibiotic selection was guideline-compliant in 52% of cases, while treatment duration complied in 96%. CT was performed in 7 patients, with no orbital abscess identified.In paediatric pre-septal cellulitis, no management guidelines were available. 3 of 23 patients (13%) received intravenous antibiotics, while 20 of 23 (87%) were treated orally, mainly with co-amoxiclav (70%). No adverse outcomes occurred.

Conclusion

Management of orbital cellulitis demonstrated excellent adherence to imaging and antimicrobial guidelines, with favourable outcomes. Greater variability was observed in pre-septal cellulitis management, particularly in paediatric cases, supporting the need for updated local protocols and standardised follow-up and documentation.

Additional Authors

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