Endoscopic vs external drainage of orbital subperiosteal abscess

Periorbital cellulitis is frequently limited to the preseptal region. However, there may be associated postseptal inflammation and orbital subperiosteal abscess (SPA). Surgical management of orbital SPA includes open drainage through an external ethmoidectomy approach, although recently the use of endoscopic techniques has been reported. This study was undertaken to evaluate postseptal cellulitis and orbital SPA in patients with periorbital cellulitis and to assess the safety and effectiveness of endoscopic management of orbital SPA. From 1989 through 1994, 158 patients were admitted with a diagnosis of periorbital cellulitis. Nineteen of these patients were diagnosed with postseptal orbital inflammation, and 14 underwent surgical drainage via an external approach, an endoscopic approach, or a combination of both. Issues addressed include (1) the role of sinus disease as the cause of periorbital cellulitis; (2) the role of computed tomographic scanning; (3) the effectiveness of aggressive medical therapy; and (4) the results of endoscopic drainage of orbital SPA compared with the external approach.