RADIOLOGICAL EVALUATION OF POST-INFECTIVE ORBITAL CELLULITIS AND VISUAL OUTCOMES: A RETROSPECTIVE STUDY AT A TERTIARY-CARE TEACHING HOSPITAL IN WESTERN UTTAR PRADESH

Abstract

Background: Post-infective orbital cellulitis remains a sight-threatening ocular emergency, most often arising from paranasal sinusitis and capable of progressing, if unrecognised, to cavernous-sinus thrombosis or intracranial extension. Contemporary management hinges on rapid radiological staging. In an Indian tertiary-care setting, the degree to which specific CT descriptors correspond to eventual visual outcome has not been well characterised.

Objectives: To describe the radiological spectrum of post-infective orbital cellulitis at our hospital, to correlate Chandler stage and individual CT findings with best-corrected visual acuity (BCVA) at 3 months, and to identify imaging predictors that independently determine poor visual outcome.

Methodology: A retrospective observational study was conducted at the School of Medical Sciences & Research (SMS&R), Sharda University, after Institutional Ethics Committee approval. Case records of all patients admitted between January and December 2015 with a clinical diagnosis of orbital cellulitis (ICD-10 H05.0/H05.1) were screened. Contrast-enhanced orbital CT (and MRI where available) were reviewed and classified per the Chandler system. Visual outcome was graded at 3 months per WHO criteria. Descriptive and inferential statistics (Chi-square, Fisher exact, Spearman correlation, Kaplan–Meier with log-rank test, and multivariable logistic regression) were performed in SPSS v22.0 with a two-sided α = 0.05.

Results: Of 218 records screened, 79 patients met the inclusion criteria (45 M, 34 F; mean age 22.8 ± 18.4 years). Paranasal sinusitis was the commonest source (53.2%). Chandler stages I–V were identified in 21, 28, 18, 8 and 4 patients, respectively. Culture-positive isolates were recovered in 60.8% (S. aureus predominant). Orbital abscess, cavernous-sinus thrombosis, optic-nerve displacement and intracranial extension each correlated strongly with poor 3-month BCVA (each p < 0.001). On multivariable analysis, orbital abscess (adjusted OR 11.94, 95% CI 3.54–40.29), cavernous-sinus thrombosis (aOR 8.25, 1.93–35.21), intracranial extension (aOR 6.55, 1.31–32.76) and optic-nerve displacement (aOR 4.66, 1.71–12.69) independently predicted blindness. Kaplan–Meier analysis showed that probability of visual recovery to ≥6/18 differed markedly by time-to-referral (log-rank χ² = 14.8, p < 0.001). The model achieved an AUC of 0.89 and classification accuracy of 84.8%.

Conclusion: Specific CT descriptors — particularly orbital abscess, cavernous-sinus involvement and intracranial extension — independently predict poor visual outcome in post-infective orbital cellulitis. The findings underscore the importance of rapid imaging-based triage and early multidisciplinary intervention at tertiary-care centres serving mixed urban–rural catchments such as that of SMS&R, Sharda University.