Age as a factor in the bacteriology and response to treatment of subperiosteal abscess of the orbit.

The clinical course of SPA of the orbit is associated with the age of the patient. That association might be explained through a series of intermediate relationships: the clinical course correlates with the bacterial constituency, the bacterial constituency is related to physiologic derangement within the sinuses, the physiologic derangement may vary with the degree of obstruction of the sinus ostia, and the ostial caliber relative to the volume of the cavity that must be drained decreases with patient age into late adolescence. The controversy between pediatricians and surgeons over the appropriate indications for drainage might be resolved with the acknowledgement that each side is correct on the basis of the patient populations treated. It is hoped that recognition of the age-related variations in SPA will permit a more systematic approach to the management of this complex infectious disease.