We reviewed the records of 22 patients with orbital cellulitis to determine the value of high resolution computerized tomography (HRCT) and standardized ultrasound (US) in their management. In 13 patients, they demonstrated abscess formation and accurately defined its location and extent. The appearance of an abscess did not necessarily mandate immediate surgery. Three patients responded promptly to intensive antibiotic therapy and resolved despite a presumptive diagnosis of orbital abscess. The remaining 10 patients required surgical intervention and abscess formation was confirmed. In patients presenting with good visual acuity and some globe motion we recommended instituting intensive intravenous antibiotic therapy for 36 hours with close monitoring of visual acuity, avoiding surgery unless some impairment of vision is noted. The decision regarding surgery is then made on the time honored basis of response to therapy. Surgery is no necessary in those patients exhibiting prompt significant improvement in local inflammatory signs.
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