When should I consider referring a patient with orbital cellulitis to secondary care?

Consider referring a patient with orbital cellulitis to secondary care urgently if there are signs of severe infection, visual impairment, or systemic symptoms. This includes any evidence of new-onset squint with neurological signs such as ataxia, vomiting, or headache, which require immediate referral to acute paediatric services if the patient is a child. Additionally, paralytic squint warrants urgent neurological assessment. Non-paralytic squint should be referred to ophthalmology services. These signs may indicate orbital involvement or complications requiring specialist management.

In general, orbital cellulitis is a serious condition that often necessitates secondary care assessment for intravenous antibiotics, imaging, and specialist ophthalmology input to prevent vision loss or intracranial complications.