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.

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 September 2, 2014 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 September 2, 2014).

Share This




More Health & Medicine News

Tuesday, September 2, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Get on Your Bike! London Cycling Popularity Soars Despite Danger

Get on Your Bike! London Cycling Popularity Soars Despite Danger

AFP (Sep. 1, 2014) Wedged between buses, lorries and cars, cycling in London isn't for the faint hearted. Nevertheless the number of people choosing to bike in the British capital has doubled over the past 15 years. Duration: 02:27 Video provided by AFP
Powered by NewsLook.com
Can You Train Your Brain To Eat Healthy?

Can You Train Your Brain To Eat Healthy?

Newsy (Sep. 1, 2014) New research says if you condition yourself to eat healthy foods, eventually you'll crave them instead of junk food. Video provided by Newsy
Powered by NewsLook.com
We've Got Mites Living In Our Faces And So Do You

We've Got Mites Living In Our Faces And So Do You

Newsy (Aug. 30, 2014) A new study suggests 100 percent of adult humans (those over 18 years of age) have Demodex mites living in their faces. Video provided by Newsy
Powered by NewsLook.com
Liberia Continues Fight Against Ebola

Liberia Continues Fight Against Ebola

AFP (Aug. 30, 2014) Authorities in Liberia try to stem the spread of the Ebola epidemic by raising awareness and setting up sanitation units for people to wash their hands. Duration: 00:41 Video provided by AFP
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:
from the past week

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