Subperiosteal orbital abscess in children: diagnosis, microbiology, and management

A chart review was undertaken of 30 patients who were presented to Children's Hospital of Pittsburgh from 1983 to 1990 and underwent surgical management for suspected subperiosteal abscess of the orbit (SPA). All patients had preoperative computerized tomography (CT) scans. Twenty-seven of 30 CT scans were reevaluated, of which 20 (74%) demonstrated findings consistent with or suggestive of SPA. Opacified sinuses were seen in 100% of this study group. Abscess collections were found in 21 patients (70%). Predominant organisms included: Streptococcus pneumoniae (38%), Streptococcus pyogenes (33%), and Haemophilus influenzae (14%); Moraxella catarrhalis was not isolated and anaerobic bacteria were isolated from only one patient. CT scans were found to be accurate predictors of SPA in 16 (80%) of 20 patients. All patients did well following surgical intervention without visual or central nervous system sequelae. We conclude from this study that CT scans should be obtained when SPA is suspected, and antimicrobial therapy should be directed toward the bacteria isolated from these abscesses.