Risk-Stratified Predictors of Clinical Progression in Adult Orbital Cellulitis: A 15-Year Cohort

The purpose of this study was to characterize clinical features, risk factors, imaging patterns, microbiology, and outcomes of adults with orbital cellulitis (OC), and to identify predictors of disease severity and surgical intervention. The authors performed a retrospective cohort study of adults greater than or equal to 18 years with clinically and radiographically confirmed OC admitted to 2 academic centers between January 2010 and March 2025 (n=176). Multivariable logistic regression identified independent predictors of subperiosteal abscess (SPA), intracranial extension (ICE), and surgical intervention; χ 2 tests, analysis of variance, and t tests were used for secondary analyses. Mean age was 47.5±18.8 years and 67.6% were male. Diabetes was present in 17.0% and was associated with older age and longer hospitalization. Imaging demonstrated SPA in 24.4%, intraorbital abscess in 10.2%, and ICE in 4.5%. Sinusitis and younger age were independent predictors of SPA; diabetes and older age were independent predictors of ICE. Overall, 58.0% required surgical intervention, with diabetes and sinusitis as independent predictors, and most patients with both comorbidities required operative treatment. Recent trauma was associated with greater surgical need and significantly longer length of stay. Staphylococcus spp. predominated on culture (45.8%), with methicillin-resistant S. aureus accounting for 15.0%. Fungal isolates occurred exclusively in diabetic hosts. Severe vision loss occurred in 22 patients, and mortality occurred in 5. Adult OC demonstrates distinct host-factor-driven patterns of severity. Diabetes and older age independently predict ICE and surgical intervention, while sinusitis predicts SPA in younger patients. These risk profiles may improve triage, guide empiric antimicrobial selection, and support timely surgical consultation.