title: Orbital Cellulitis and Subperiosteal Abscess: A 5-year Outcomes Analysis.
abstract: OBJECTIVE
  Orbital cellulitis and subperiosteal abscess (SPA) are historically associated with poor outcomes. We seek to characterize current associations with abscess formation, surgical failure and vision loss.
  
  
  METHODS
  All cases of orbital cellulitis presenting to an affiliated hospital between April 2008 and 2013 were critically reviewed.
  
  
  RESULTS
  Thirty patients met inclusion criteria. Average age was 28.7 ± 24.4. The male to female ratio was 2:1. Abscesses were identified in 56.7% of patients. Adults were less likely than children to present with abscesses (28.6% vs. 81.3%, p = 0.008). Of the other factors analyzed, only antibiotic use before admission (70.5% vs. 23.1%, p = 0.03) and maximum restriction (-2.5 ± 1.2 vs. -0.9 ± 0.7, p = 0.008) were associated with SPA. Temperature at presentation (37.9 ± 0.9 vs. 37.1 ± 0.4, p = 0.04), relative proptosis (5.8 ± 3.3 mm vs. 2.1 ± 1.1, p = 0.002) and abscess volume (4.3 ± 1.3 mm(3) vs. 0.7 ± 0.5 mm(3), p = 0.0004) were associated with progression to surgery. Reoperation was required in 26.7% of patients. Of these, two-thirds had combined superior/medial abscesses that re-accumulated after isolated endonasal surgery. Two of the 3 patients with profound vision loss had a dental etiology.
  
  
  CONCLUSIONS
  Only young age, prior antibiotics and degree of restriction predicted the presence of an abscess. Re-accumulation was more common than anticipated, and drainage of superior/medial abscesses by endoscopic surgery alone had the strongest association with surgical failure. Patients with odontogenic abscesses must be treated with particular caution.
authors: Bascom Palmer Eye Institute , Miami, Florida , USA.
authors: Benjamin P
authors: BP
authors: Erickson
authors: Wendy W
authors: WW
authors: Lee
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods; D015521:Ethmoid Sinusitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D008297:Male; D015523:Maxillary Sinusitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D008875:Middle Aged; D054517:Orbital Cellulitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D010521:Periosteum / Q000382:microbiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Microbiology; orbital cellulitis; sinusitis; subperiosteal abscess