Criteria for nonsurgical management of subperiosteal abscess of the orbit - Analysis of outcomes 1988-1998

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. Ophthalmology 2000; 107:1454-7458 (C) 2000 by the American Academy of Ophthalmology.