Pediatric orbital subperiosteal abscess outbreak in Iran: characteristics and causes
Seyed Mohsen Rafizadeh1 *, Mohammad Taher Rajabi1 , Pedram Afshar1 , Amirhossein Aghajani1 , Navid Mohsenzadeh1 , Mostafa Heidari1 , Zohreh Abedinifar2
- Department of Orbital and Oculoplastic Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pathology and Microbiology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract: To evaluate demographics, characteristics, and management of pediatric patients with subperiosteal abscesses
(SPA) secondary to orbital cellulitis and discuss the etiology of a dramatic rise in SPA.
Methods: Data were gathered by retrospective chart review of patients admitted to a tertiary referral eye hospital (Farabi
Eye Hospital) diagnosed with orbital cellulitis with subperiosteal abscess from October 2022 to March 2023 (six months).
Data on demographic information, clinical examination, radiographic evidence of sinusitis, orbital cellulitis, SPA, surgical
and non-surgical management taken, isolated bacteria, and duration of hospital stay were gathered.
Results: 24 patients were admitted during these six months, with a diagnosis of orbital SPA secondary to paranasal sinusitis,
confirmed by an orbital Computed Tomography (CT) scan. The age range was 11 months to 16 years. 75% of patients were
male. All patients had a history of flu-like illness before developing orbital cellulitis. All patients had concurrent sinusitis,
and 18 underwent initial surgical abscess drainage. The ethmoid sinus was the most involved, and most patients had a medially located SPA. Abscess volume ranged from 0.78 to 7.81 cm3 (mean: 3.52 cm3). One patient had concurrent central retinal artery occlusion due to orbital cellulitis.
Conclusion: In this study, we report a dramatic increase in the incidence of SPA referred to our hospital. Larger abscess
volumes and an increased number of cases that needed initial surgical drainage are also of note. An influenza outbreak in
the autumn and winter, undiagnosed Corona Virus Disease 2019 (COVID-19) infection, increased antimicrobial resistance
due to excessive off-label use of antibiotics during the COVID-19 pandemic, and more virulent bacterial infections are the
most probable hypotheses to justify this observation.
