Criteria for nonsurgical management of subperiosteal abscess of the orbit22: Analysis of outcomes 1988–1998
Presented in part at the annual meeting of the American Academy of Ophthalmology, Orlando, Florida, October 1999.
Abstract
Purpose
On the basis of bacteriologic studies, we have recommended expectant observation with intravenous antibiotics for subperiosteal abscess (SPA) of the orbit in patients less than 9 years of age, given the absence of eight other specific surgical criteria. We attempted to test these recommendations with a prospective study.
Study design
Prospective noncomparative case series.
Participants
Forty patients younger than 9 years of age treated for orbital SPAs at the Childrens Hospital of Wisconsin from 1988 to 1998.
Methods
Specific management criteria were applied to a cohort of 37 orbital SPA patients. Three other orbital SPA patients under the age of 9, either ineligible for medical therapy or treated outside our guidelines, were also studied. Clinical data for all patients were reviewed and analyzed.
Main outcome measures
Clinical resolution of the abscess, as evidenced by normal visual acuity, pupillary examination, motility, and globe position on the affected side.
Results
Eight patients met criteria for surgical treatment and underwent prompt drainage. Of the 29 patients for whom initial nonsurgical management was recommended, 27 (93.1%) SPAs cleared with expectant observation on intravenous antibiotics, and 2 patients defaulted to surgical intervention. All cases had successful clinical outcomes.
Conclusions
In patients less than 9 years of age, orbital SPAs are likely to resolve without surgery, provided certain surgical criteria are absent.
Manuscript no. 99456.
aDivision of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Reprint requests to George H. Garcia, MD, 1201 W. La Veta, Suite 406, Orange, CA 92868
ABSTRACT