When do you consider adding steroids alongside intravenous antibiotics for patients with orbital cellulitis?  

I remember several lively debates in fellowship between ophthalmology and ENT about when and if to start systemic steroids in orbital cellulitis, particularly when there is adjacent sinusitis, which is overwhelmingly the case. I think another relevant question is whether starting intranasal steroids...

Timing this is a case-by-case decision. I am fairly aggressive in using IV steroids early on. They really cool things down and improve comfort.

If the orbital cellulitis is infectious, I never add steroids. There is no literature or proof that they do anything, and decreasing immunity, in my opinion, is simply a bad idea. If it is inflammatory, then absolutely. Most infectious orbital cellulitis is from the sinuses and is more common in chi...