A recent study presented at the Association for Research in Vision and Ophthalmology (ARVO) 2025 Annual Meeting evaluated the visual outcomes after orbital cellulitis (OC) infections for patients with and without diabetes.
Give me some background.
OC is a serious infection that involves the muscle and fat located within the orbit—though it does not impact the globe itself.
Without treatment, OC can lead to vision- and life-threatening complications, such as:
- Vision loss
- Subperiosteal abscess
- Orbital abscess
- Intracranial extension of the infection
To note: Individuals with type 2 diabetes mellitus (T2DM) generally have a higher susceptibility to aggressive infections.
As such: A team of researchers from Drexel University College of Medicine in Philadelphia, Pennsylvania and the Wilmer Eye Institute at Johns Hopkins University in Baltimore, Maryland, hypothesized that T2DM patients may experience worse clinical outcomes than non-diabetics after OC.
Next: Talk about the presentation.
In this retrospective comparative cohort study, investigators utilized the TriNetX Research Network to identify adults (≥ 18 years) diagnosed with OC over a 20-year period, between October 28, 2004 and October 28, 2024.
- The exclusion criteria: Those with globe malformation or acquired anophthalmia.
Patients were organized into two groups:
- T2DM patients with OC: 5,202 (mean age 65.3±15.3 years, 53.3% white, 52.4% female)
- Non-diabetic patients with OC: 5,202 (mean age 66.0±16.3 years, 57.0% white, 52.5% female)
And what was measured?
Primary outcome measures: New diagnoses of poor vision (i.e., blindness / low vision; International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM H54]) and enucleation at 3 and 6 months post-OC.
Secondary outcomes: Risk factors for these outcomes in T2DM patients.
Findings?
At 3 months, poor vision occurred in 7.5% of T2DM patients compared to 4.3% of non-diabetics (p < 0.001, relative risk [RR]: 1.75 [95% confidence interval (CI): 1.49-2.06]).
Enucleation rates were 0.7% in T2DM patients vs. 0.5% in non-diabetics (p = 0.190, RR: 1.42 [95% CI: 0.84-2.39]).
Anything else?
At 6 months, poor vision rates rose to 7.8% in T2DM patients compared to 4.6% in patients without diabetes (p < 0.001, RR: 1.68 [95% CI: 1.44-1.97]).
In T2DM patients, poor vision was associated with the following risk factors:
- Chronic sinusitis (p < 0.001)
- Neovascular glaucoma (p = 0.002)
- Glucocorticoid use (p < 0.001)
- Zygomycosis (p = 0.002)
- Enucleation was also associated with Zygomycosis infection (p < 0.001)
Take home.
These findings demonstrate that patients with T2DM were significantly more likely to develop poor visual outcomes at 3 and 6 months post-OC—potentially as a result of increased susceptibility to severe infections.
- Note: Enucleation rates did not differ statistically between groups.
Careful management and follow-up are crucial for OC in T2DM patients to mitigate adverse outcomes, particularly for those with the additional risk factors listed above.