If orbital cellulitis is suspected, what is the most appropriate next step?

• A. CT scan of orbits and sinuses
• B. Observation
• C. Topical antibiotic drops
• D. Oral decongestants

Answer: (A)

Orbital cellulitis is an urgent infection where the space behind the orbital septum becomes involved, so you need to confirm the extent of infection and look for sources like sinus disease. The best next step is a CT scan of the orbits and sinuses with contrast. This imaging quickly shows whether the infection is confined to the preseptal area or has spread into the orbit, whether there’s a subperiosteal abscess or other complications, and it also reveals sinus disease that often underlies orbital infection. The result guides immediate management, typically prompting hospital admission and IV broad-spectrum antibiotics, and it helps plan any surgical needs.

Other options aren’t appropriate for this scenario: observation misses a potentially vision-threatening progression, topical antibiotic drops don’t reach the orbit, and oral decongestants don’t treat an active orbital infection and can delay necessary therapy.