I read the article by Froehlich et al,1 and found that their approach to drainage of an opacified ethmoid sinus and subperiosteal orbital space is direct and easily accessible through the bulla ethmoidalis and the lamina papyracea. However, their criteria for patient selection for surgery is concerning. Not every patient with subperiosteal orbital abscess and associated sinus disease needs surgical drainage. Specifically, Harris2 has reported that age is a risk factor in response to treatment of a bacterial subperiosteal abscess: 83% of patients younger than 9 years cleared without surgical drainage. Serial clinical and radiographic examinations should guide therapy. Criteria for surgery should include worsening visual acuity, development of an afferent pupillary defect, progressive proptosis, decreased ocular motility (not orbital mobility), and increased intraocular pressure secondary to orbital compression. Progression showed on a computed tomographic scan of the abscess may not be predictive of final outcome.3 Patients with subperiosteal orbital abscess and sinus disease should be comanaged by ophthalmologists and ear, nose, and throat surgeons.
Burnstine MA. Minimal Endoscopic Approach. Arch Otolaryngol Head Neck Surg. 1998;124(6):711. doi:10.1001/archotol.124.6.711
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