Criteria for nonsurgical management of subperiosteal abscess of the orbit: analysis of outcomes 1988-1998.
OBJECTIVE
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.


METHODS
Prospective noncomparative case series.


METHODS
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.


METHODS
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.
Division of Orbital and Ophthalmic Plastic Surgery, Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
G H
GH
Garcia
G J
GJ
Harris
D000038:Abscess / Q000000981:diagnostic imaging / Q000628:therapy*; D000900:Anti-Bacterial Agents; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D010521:Periosteum; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents