Frank abscesses should be evacuated urgently. Small subperiosteal abscesses with normal vision, normal EOMI, mild proptosis may be treated conservatively with IV antibiotics. All patients with orbital complications managed medically should be closely observed with frequent visual checks. Patients who experience a decrease in visual acuity, worsening extraocular muscle function or failure to improve in 48-72 hours should undergo surgical sinus drainage. The ethmoids, frontal, and sphenoid sinusitis primarily responsible.
Infection is spread via thrombophlebitis or less commonly via direct extension of infection.
High morbidity and mortality despite antibiotics and aggressive treatment still exist. Streptococcal species are most commonly responsible for CNS complications. Exceptions include cerebral abscess and epidural abscess near a focus of osteomyelitis when Staph is more common. The treatment for each of these complications is similar. A CT scan to evaluate for other CNS complications and cerebral midline shift or mass effect is necessary.