Comparison of management and characteristics of orbital and preseptal cellulitis in adult patients with and without diabetes mellitus: a retrospective cohort study

To examine how type 2 diabetes mellitus influences the presentation and management of preseptal and orbital cellulitis. A retrospective study at a tertiary care center identified patients presenting with preseptal and orbital cellulitis between 2000 to 2022. Data collected included demographics, presentation, management, and follow-up characteristics. Of the 382 patients, 187 (49.0%) had preseptal cellulitis and 195 (51.0%) had orbital cellulitis. Diabetes was present in 19.8% and 23.6% of patients with preseptal and orbital cellulitis, with similar mean A1C levels (8.24 versus 7.96, p = .410). In the preseptal cellulitis cohort, diabetic patients were more likely to be admitted (56.8% versus 35.3%, p = .045). In the orbital cellulitis cohort, diabetic patients had longer hospital stays (median 6.0 versus 4.0 days, p = .004), longer intravenous antibiotics duration (median 4.0 days, p = .005), and received steroids later (median day 2.0 versus 1.0, p = .018). Patients with diabetes presented with worse visual acuity (median 0.40 versus 0.18 logMAR, p = .005) and a higher rate of relative afferent pupillary defect (47.2% versus 18.5%, p = .001). Extraocular movement (EOM) restriction was significantly more common in diabetic patients at follow-up (47.6% vs. 14.1%, p < .0001). The overall readmission rate was higher in diabetic patients (19.6% vs. 8.7%, p = .043). Patients with diabetes and preseptal cellulitis had a higher inpatient admission rate and longer duration stays than patients without diabetes. Patients with diabetes and orbital cellulitis had longer hospital stays, longer intravenous antibiotics duration, worse visual acuity at diagnosis, and a higher EOM restriction rate at follow-up compared to patients without diabetes.