When orbital cellulitis arises in an immunocompromised patient, or in the setting of diabetes mellitus or prolonged corticosteroid or antibiotic use, a fungal aetiology must be actively considered. This population requires a distinct clinical approach that differs from standard antibacterial management.
A high index of suspicion for fungal orbital cellulitis is warranted in immunocompromised patients, in those with diabetes mellitus, and in patients receiving chronic steroid or antibiotic regimens. Fungal cover should also be considered when the infection does not respond to first-line therapy in these populations.
Treatment involves targeted antifungal therapy alongside correction of the patient's underlying systemic risk factors. The complete protocol — including the surgical component and full sequenced regimen — is available below.