Prospective application of a protocol for selective nonsurgical managementof suspected orbital subperiosteal abscesses in children

Goodwin et al (1982) and Souliere et al (1990) have proposed a protocol for the selective nonsurgical management of suspected orbital subperiosteal ab scesses. This protocol has been routinely applied by the Temple Pediatric O tolaryngology and Ophthalmology services since 1990, During this period, ch ildren with computed tomography and physical examination findings consisten t with orbital subperiosteal abscesses and visual acuity better than 20/60 were treated with intravenous antibiotics rather than immediate surgery. Th ey were followed with frequent ophthalmologic examinations and operated upo n if vision deteriorated or they failed to improve clinically within 48 hou rs. A review of patients admitted to St Christopher's Hospital for Children , the site of Temple University's pediatric activities in the years from 19 91 to 1997, revealed 14 patients with clinical evidence of orbital subperio steal abscesses. Twelve patients were treated in accordance with the Goodwi n-Souliere protocol. All recovered completely without surgical intervention and without any adverse sequelae. Selective nonsurgical treatment of clini cally diagnosed orbital subperiosteal abscesses in children is relatively s afe and effective.