Orbital Abscesses

Abstract

Orbital abscess is a serious form of orbital infection. The suppurative collection may be found along the orbital walls (subperiosteal abscess) or in the extraconal and intraconal spaces (true intraorbital abscess). Infection from contiguous structures (especially paranasal sinusitis) is the most common predisposing factor. Most patients present with painful, unilateral periorbital swelling and erythema, chemosis, proptosis, visual impairment, and ophthalmoplegia. Systemic features include fever and malaise. Fungal infections may have a more chronic, indolent presentation. Neurologic manifestations are associated with intracranial spread of the infection. CT scan remains the imaging investigation of choice for the diagnosis. A complementary MRI may be needed in cases with intracranial involvement and/or in the differential diagnosis of other orbital diseases. Ultrasonography is useful to assess the response to treatment. The most common microorganisms are those encountered in paranasal sinusitis. Fungal pathogens are rare. Orbital abscesses generally require surgical drainage. Conservative management consisting of intravenous antibiotics and close ophthalmological and clinical monitoring may be suggested for small suppurative collections with no signs of complication, but surgery should be reconsidered if complications arise. The outcome is generally good but is related to the severity of intracranial infections and the delay in diagnosis (potential blindness).