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Orbit. 2015 Jun;34(3):115-20. doi: 10.3109/01676830.2014.950286. Epub 2015 Apr 13.

Orbital Cellulitis and Subperiosteal Abscess: A 5-year Outcomes Analysis.

Author information

1
Bascom Palmer Eye Institute , Miami, Florida , USA.

Abstract

PURPOSE:

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.

KEYWORDS:

Microbiology; orbital cellulitis; sinusitis; subperiosteal abscess

PMID:
25867948
DOI:
10.3109/01676830.2014.950286
[Indexed for MEDLINE]

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