The acute orbit: differentiation of orbital cellulitis from subperiosteal abscess by computerized tomography

A series of 65 patients suffering from acute inflammatory disease of the orbit was studied by CT. Ethmoiditis was the cause in the vast majority; trauma and dental extraction played a lesser role in causation. Orbital cellulitis was diagnosed in 17 and subperiosteal abscess in the remaining 48. It was not possible to differentiate 33 pus-containing abscesses from the six with inflammatory masses (phlegmons). The satisfactory response to aggressive medical treatment in those patients with inflammatory masses that were not drained justifies a more conservative approach; surgical drainage being reserved for those with a deterioration in proptosis, ocular movements or vision. Six abscesses arose de novo, of which some were in the orbital fat rather than the subperiosteal space.