Purpose of review: Many paediatric orbital subperiosteal abscesses (SPA) are effectively managed conservatively with systemic antibiotics, but surgical drainage is required in some patients. This review aims to summarize the current literature to determine predictors of surgical intervention.
Recent findings: Nearly all the data regarding this topic come from analysis of retrospective case series. There is consensus that large volume SPAs require surgical drainage; however, the cutoff for volume differs between studies. Proptosis more than 5 mm, superior location of SPA and patient age more than 9 years are also all factors that may predispose towards surgical treatment.
Summary: A conservative approach may be trialled in younger patients with medial, smaller volume SPAs. Larger volume SPA, presence of proptosis, superior location of SPA and patient age more than 9 years should lower the threshold for considering surgical intervention. Given that many studies have been retrospective, future studies should be prospective and specifically aim to determine a cutoff for SPA volume.