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Medical management of orbital subperiosteal abscess in children
1Division of Ophthalmology, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
Insights
Antibiotics alone can successfully treat subperiosteal orbital abscess in children. This approach offers a viable alternative to surgery for pediatric orbital infections, potentially avoiding invasive procedures.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Medical Imaging
Background:
- Subperiosteal orbital abscess traditionally requires surgical drainage and antibiotics.
- Orbital cellulitis with subperiosteal abscess often co-occurs with ethmoid sinusitis.
Observation:
- Eleven children with orbital cellulitis and subperiosteal abscess were treated.
- Nine children were successfully treated with antibiotics alone; two others were treated retrospectively with non-surgical therapy.
- All patients presented with normal vision, which was monitored closely.
Findings:
- Intravenous antibiotic therapy led to improvement in all patients.
- Ten out of eleven patients achieved clinical cure with medical therapy alone.
- Post-treatment CT scans confirmed resolution in five patients, with no recurrences observed.
Implications:
- Orbital subperiosteal abscess may be treatable with antibiotics alone, challenging current diagnostic criteria.
- Non-surgical management with intravenous antibiotics should be considered for pediatric patients with subperiosteal abscess and contiguous ethmoid sinusitis, especially when optic nerve function is not compromised.
- This suggests a potential need to revise CT scan criteria for diagnosing subperiosteal orbital abscess.
Abstract:
The traditional treatment of subperiosteal orbital abscess consists of surgical drainage and antibiotic therapy. We successfully treated with antibiotics alone nine children (age range 26 months to 12 years) with clinical signs and symptoms of orbital cellulitis and computerized tomographic (CT) evidence of subperiosteal abscess and contiguous ethmoid sinusitis. Two additional patients successfully treated with nonsurgical therapy were identified retrospectively. All patients were admitted to the pediatric service with normal vision. Their visual function was assessed twice daily during the early stages of their illness. All patients improved with intravenous antibiotic therapy. One additional patient required surgical drainage for persistent pain after 1 week of slow but steady clinical improvement. All other patients were clinically cured with medical therapy alone. Five of the medical "cures" had posttreatment CT, which documented the resolution. No patient had a recurrence. We conclude that orbital subperiosteal abscess, like some other abscesses located elsewhere, may be amenable to non-surgical treatment, or that these patients may have had a phlegmon rather than an abscess and the currently accepted CT criteria for diagnosis of a subperiosteal abscess may require modification. We recommend that children with a subperiosteal abscess from contiguous ethmoidal sinusitis who have no evidence of compromised optic nerve function be given a trial of intravenous antibiotic therapy prior to consideration of surgical drainage.