Featured Research

from universities, journals, and other organizations

Treating children's eye infections without surgery

Date:
June 8, 2011
Source:
Lifespan
Summary:
Researchers report that medical management may be preferred over surgery for children with orbital cellulitis, an acute infection of the tissues surrounding the eye. They have determined the criteria for surgical intervention should be dependent upon the size of a subperiosteal abscess.

Researchers from Hasbro Children's Hospital in Providence, R.I., report that medical management may be preferred over surgery for children with orbital cellulitis, an acute infection of the tissues surrounding the eye. They have determined the criteria for surgical intervention should be dependent upon the size of a subperiosteal abscess (SPA). The research is published in the journal Ophthalmic Plastic & Reconstructive Surgery and is now available online in advance of print.

Related Articles


Orbital cellulitis is most often the result of bacteria from a sinus infection, but may also be caused by a stye, a bug bite or a recent injury to the eyelid. It requires immediate medical attention to avoid further complications such as meningitis or loss of vision. In some cases, the infection will progress to a SPA. In these cases, surgery to drain the abscess and antibiotic therapy has been the usual course of treatment.

Through new research, Yoash Enzer, M.D., an ophthalmologist with Hasbro Children's Hospital, has found that the size of the abscess should be a determining factor in whether surgery is required for treatment. In his study the charts of 29 patients were reviewed; eight were managed surgically and 21 were managed medically. Frontal sinusitis was found in 11 of 17 patients who had CT scans, and four of those patients underwent surgical drainage, but only two of those patients showed positive culture results. Those two patients had an SPA volume that was greater than 1,250 millimeters.

Enzer says, "The management of pediatric orbital cellulitis with an SPA has been largely surgical until the early 1990s when it was suggested that simple, aerobic infections were found in children under age nine, while older children had more complex microbial infections. In our study, however, patients both under nine and over nine required surgical intervention when the SPA volumes were greater than 1,250 millimeters."

In the paper, Enzer and his colleague propose that measuring the SPA volume using CT scan measurements should be considered as one of the most important criteria in determining the need for surgical drainage, regardless of age. Although age should be taken into account as a definite trend, it is equally important to emphasize that children both under and over the age of nine may require surgical drainage of the SPA. "Furthermore, we would make the argument that SPA regardless of volume size coupled with frontal sinusitis should make the clinician have an even lower threshold for surgical drainage than would normally be used in the same case without the presence of frontal sinusitis because of the added risk of developing an intracranial abscess," comments Enzer.

Enzer adds, "Our study found that larger abscesses are more likely to require surgical management. The approach to orbital cellulitis should be interdisciplinary and include the pediatric, otolaryngology, and ophthalmology teams, and, if necessary, neurosurgery. And at least one daily, thorough ophthalmologic clinical exam with special attention to visual acuity changes, persistent fevers, extraocular motility and pupillary exam testing should be performed, despite the difficulties in doing so in this population." He adds if there is no improvement or worsening clinically after 24 to 48 hours of medical management with antibiotic treatment, repeat imaging should be performed and surgical drainage considered.

"Avoiding surgery when medical management options exist is preferable for our patients and their families, and for the health system as a whole, but must be done with close monitoring. This study clarifies which pediatric patients are best suited for surgery, and which can be managed medically," Enzer concludes.

Michele Todman, M.D., was also involved in the study with Enzer. Both are from the department of ophthalmology at Rhode Island Hospital/Hasbro Children's Hospital.

Enzer's principle affiliation is Rhode Island Hospital and its Hasbro Children's Hospital, a member hospital of the Lifespan health system in Rhode Island, and direct financial and infrastructure support for this project was received through the Lifespan Office of Research Administration. The researcher also has an academic appointment at The Warren Alpert Medical School of Brown University. Enzer's research is fully supported by Hasbro Children's Hospital and the Lifespan health system.


Story Source:

The above story is based on materials provided by Lifespan. Note: Materials may be edited for content and length.


Journal Reference:

  1. Michele S. Todman, Yoash R. Enzer. Medical Management Versus Surgical Intervention of Pediatric Orbital Cellulitis: The Importance of Subperiosteal Abscess Volume as a New Criterion. Ophthalmic Plastic & Reconstructive Surgery, 2011; DOI: 10.1097/IOP.0b013e3182082b17

Cite This Page:

Lifespan. "Treating children's eye infections without surgery." ScienceDaily. ScienceDaily, 8 June 2011. <www.sciencedaily.com/releases/2011/06/110608122554.htm>.
Lifespan. (2011, June 8). Treating children's eye infections without surgery. ScienceDaily. Retrieved March 29, 2015 from www.sciencedaily.com/releases/2011/06/110608122554.htm
Lifespan. "Treating children's eye infections without surgery." ScienceDaily. www.sciencedaily.com/releases/2011/06/110608122554.htm (accessed March 29, 2015).

Share This


More From ScienceDaily



More Health & Medicine News

Sunday, March 29, 2015

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

S. Leone in New Anti-Ebola Lockdown

S. Leone in New Anti-Ebola Lockdown

AFP (Mar. 28, 2015) — Sierra Leone imposed a three-day nationwide lockdown Friday for the second time in six months in a bid to prevent a resurgence of the deadly Ebola virus. Duration: 01:17 Video provided by AFP
Powered by NewsLook.com
These Popular Antibiotics Can Cause Permanent Nerve Damage

These Popular Antibiotics Can Cause Permanent Nerve Damage

Newsy (Mar. 27, 2015) — A popular class of antibiotic can leave patients in severe pain and even result in permanent nerve damage. Video provided by Newsy
Powered by NewsLook.com
WH Plan to Fight Antibiotic-Resistant Germs

WH Plan to Fight Antibiotic-Resistant Germs

AP (Mar. 27, 2015) — The White House on Friday announced a five-year plan to fight the threat posed by antibiotic-resistant bacteria amid fears that once-treatable germs could become deadly. (March 27) Video provided by AP
Powered by NewsLook.com
House Ready to Pass Medicare Doc Bill

House Ready to Pass Medicare Doc Bill

AP (Mar. 26, 2015) — In rare bipartisan harmony, congressional leaders pushed a $214 billion bill permanently blocking physician Medicare cuts toward House passage Thursday, moving lawmakers closer to resolving a problem that has plagued them for years. (March 26) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins