Although antibiotics are the best initial treatment, surgical intervention is warranted when a child has: visual impairment, complete ophthalmoplegia, or well-defined abscess on presentation, or no clearly apparent clinical improvement by 24 hours (strength of recommendation [SOR]: C, based on patient-oriented case- series studies). Target antimicrobial therapy toward the common pathogens associated with pre- disposing factors for orbital cellulitis, such as sinusitis--and pay attention to local resistance patterns (SOR: C, based on patient-oriented case series)
