Orbital Abscesses: A Systematic Review of Clinical Presentation, Diagnostic Tools, and Treatment Modalities

Orbital abscesses, though rare, represent a serious complication of sinusitis and can result in significant morbidity, including permanent vision loss and intracranial spread if not managed promptly. This systematic review aims to provide a detailed analysis of the clinical presentation, diagnostic modalities, treatment approaches, and outcomes in patients with orbital abscesses. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across PubMed and Scopus, yielding 19 studies involving 36 patients with orbital abscesses. Data extraction focused on study design, sample size, patient demographics (age, gender), clinical presentation, diagnostic tools, treatment modalities, and outcomes, including resolution rates, complications, and recurrence. Orbital abscesses primarily affected younger populations, with a mean patient age of nine years. The most common symptoms solicited were proptosis at 75%, periorbital swelling at 80%, and pain at 70%. The diagnostic modality used in the majority, 89%, was imaging with computed tomography. All cases were given empiric intravenous antibiotics and third-generation cephalosporins, with added metronidazole. Of all the patients, 44% had to undergo any surgical intervention, usually in cases of larger abscesses or where the optic nerve was implicated. Endoscopic sinus surgery (ESS) was the most frequently used surgical approach, with a high success rate. A total of 78% of patients achieved complete resolution, and 80% experienced improved visual acuity. However, delayed intervention led to permanent vision loss in 5.5% of cases, highlighting the importance of timely treatment. The median hospital stay ranged from one to two weeks, depending on the severity of the condition and the treatment modality. Managing an orbital abscess requires early detection and treatment to avoid complications like loss of vision and intracranial extension. Smaller, medially located abscesses can be effectively treated with conservative antibiotic therapy, while larger or complicated cases require surgical treatment.