Epidemiology of Orbital and Preseptal Cellulitis in the United States: A 13-Year Analysis

Purpose: To determine the incidence rates, risk factors, and economic burden of orbital and preseptal cellulitis in the United States (US). Methods: This retrospective longitudinal study was completed using data from the US Nationwide Emergency Department Sample dataset. An estimated 732,105 emergency department (ED) visits with a primary or secondary diagnosis of orbital and preseptal cellulitis from 2006 to 2018 were included. Incidence rates, descriptive statistics, and risk factors were calculated using linear and multivariate logistic regression models. Results: The incidence rates of preseptal cellulitis increased from 6.2 in 2006 to 19.2 per 100,000 US population in 2018. In contrast, orbital cellulitis incidence rates have been decreasing from 6.1 to 2.8 per 100,000 US population from 2006 to 2018, respectively. Young adults (ages 21–44) comprise a majority of patients with either preseptal or orbital cellulitis (31.7%; 95% CI, 30.5–33.0%). Hypertension (11.8%, 12.9%), tobacco use (11.2%, 9.6%), and sinusitis (9.2%, 4.3%) were the most commonly associated diagnoses for orbital and preseptal cellulitis, respectively. Only 27.6% of patients with orbital cellulitis were admitted with 64.7% of patients routinely discharged. The inflation-adjusted ED charges for patients with orbital and preseptal cellulitis from 2006 to 2018 totalled over $997 million. Conclusion: Orbital and preseptal cellulitis are costly infections in the US with increasing incidence rates for preseptal cellulitis. High rates of routine discharge from the ED for orbital cellulitis may represent a knowledge gap amongst providers and an opportunity to improve care. Identifying individuals at risk for infection is key for diagnosis and appropriate triage of care.