Superiorly based subperiosteal orbital abscess: an uncommon presentation

Area of Science:

• Otolaryngology
• Ophthalmology
• Infectious Disease

Background:

• Subperiosteal orbital abscesses (SOAs) are severe complications of rhinosinusitis, potentially leading to vision loss.
• SOAs typically occur on the medial orbital wall due to ethmoid sinusitis.
• Superiorly based SOAs are uncommon, often stemming from frontal sinusitis.

Observation:

• A 32-year-old female presented with severe facial pain, proptosis, and diplopia.
• Endoscopy revealed purulent discharge and nasal polyps.
• Imaging confirmed a superiorly located subperiosteal abscess on the orbital roof.

Findings:

• The patient underwent surgical drainage of the abscess using a combined endoscopic and external approach (Lynch-Howarth incision).
• Rapid postoperative improvement was observed.
• The patient experienced an uneventful recovery and follow-up.

Implications:

• Combined endoscopic and external approaches may be necessary for superiorly based SOAs, which are challenging to treat endoscopically alone.
• Prompt surgical management is crucial for preserving vision in patients with SOAs.
• This case highlights the importance of considering frontal sinusitis in superiorly located orbital abscesses.