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We thank Dr Burnstine for his comments. All our patients are seen and followed up by the pediatric ophthalmology service in conjunction with the pediatric otolaryngology service. Serial clinical examinations are performed. Frequently, the patient is admitted to the hospital with periorbital edema and erythema, and the computed tomographic scan is not obtained immediately but is performed only after the child has failed to respond to aggressive intravenous antimicrobial therapy and shows clinical signs of continued disease with fever, increased periorbital swelling, and progression of ophthalmologic signs. The decision for surgical intervention in our institutions is carried out with input from the pediatric ophthalmology service.
There are several concerns regarding reliance on medical management. In the last few years, there has been an explosion of resistant organisms and, just as nonresponsive otitis media is treated with tympanocentesis, yielding both culture material and often clinical cure, so too can rapid diagnosis and cure be achieved with drainage of the subperiorbital abscess. In addition, it has been our experience that children more readily and rapidly respond to the straightforward surgical drainage procedure described in our article and are able to be discharged from the hospital in a shorter period than those who are observed while receiving prolonged intravenous antimicrobial treatment.
Last, although it would be ideal to perform serial computed tomographic scans, frequently these infections involve younger children who require sedation for the procedures and multiple serial computed tomographic scans bring with them concerns for radiation exposure and repetitive anesthesia.
Froehlich P, Pransky SM. Minimal Endoscopic Approach—Reply. Arch Otolaryngol Head Neck Surg. 1998;124(6):711. doi:10.1001/archotol.124.6.711
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