(1238) Identifying Risk Factors for Orbital Complications in Patients with Chronic Sinusitis: A Case-Control Study

Introduction: Orbital cellulitis (OC) is a rare but serious complication of both acute (ARS) and chronic rhinosinusitis (CRS), with treatment often requiring hospitalization for IV antibiotics and surgery, and consequences including permanent vision loss. Compared to patients with ARS, relatively little study has been done on specific risk factors for orbital complications in adult CRS patients, potentially due to a lack of comprehensive documentation; CRS is usually diagnosed and treated in outpatient settings while OC is managed inpatient. We aimed to identify specific risk factors that may be associated with the development of OC in adult patients with CRS.

Methods: A retrospective chart review was conducted at a major urban tertiary healthcare center associated with multiple outpatient sites over 10 years. Patients who met AAO-HNSF criteria for CRS with an ensuing diagnosis of OC were identified and matched 1:3 by age, sex, and race to patients with only CRS. Fisher’s exact tests were done to compare groups. Comorbidities for cases were assessed at the time of OC development.

Results: 14 cases met criteria (mean age 69.2). 50% were female. Demographic distribution was 64.2% White, 21.4% Black, and 14.2% Asian or Hispanic. Cases were more likely than controls to be on immunosuppressive medication (28.6% vs 2.4%, p< 0.012) and have COPD (35.7% vs 4.8%, p< 0.008). Other analyzed comorbidities (including diabetes, GERD, malignancy, OSA, autoimmune disease, and smoking) were not significantly different. Asthma rate was higher in cases, although not statistically significant (42.9% vs 16.7%, p=0.067).

Conclusions: Immunosuppression and COPD may be associated with OC development in adults with CRS. Further study at tertiary care centers is needed to clarify risk factors and improve management for CRS patients.