Orbital abscess. Presentation, diagnosis, therapy, and sequelae.

Fifteen cases of orbital abscess were reviewed. Significant morbidity occurred despite treatment with intravenous antibiotics and surgical drainage. The complications included visual loss to less than 20/200 (four patients), residual proptosis (two patients), residual diplopia (two patients), osteomyelitis (one patient), and death (one patient). Seven patients reported no pain. Fever was absent in eight patients. Four patients had normal white blood cell counts. Many of these patients had received inappropriate or inadequate doses of oral antibiotics before referral. Partially treated cases of orbital abscess may not manifest the expected clinical findings of orbital infection. Four patients presented in an insidious fashion with symptoms evolving over weeks to months. Their subacute presentations in the absence of fever, pain, or elevated white blood cell count mimicked the onset of orbital tumors. CT scan failed to detect an abscess in two cases. Conjunctival and nasal cultures were not helpful in determining the bacteriologic etiology of these infections. Surgical drainage and appropriate antibiotic therapy is the definitive treatment of orbital abscess.