When should we perform surgery in orbital complication due to rhinosinusitis?

Objective: In our study, we aimed to find out which factors the treatment method depends on in orbital complications and to shape the treatment scheme according to these factors. Material and Methods: Patients who were treated and followed up for orbital complications of rhinosinusitis in the Karadeniz Technical University, Faculty of Medicine, Department of Otorhinolaryngology, between 2007 and 2018 were retrospectively analyzed. A total of 64 patients were included in the study. Abscess volume and proptosis values of the patients with subperiosteal and orbital abscesses were calculated. The operative approach was recorded in patients treated surgically. Results: It was determined that 48.4% of the patients were children and 51.6% were adults. The mean age was calculated as 26.3±20.5 years. Of these, 25% of the patients were female and 75% were male. Abscess was detected in 10 patients (15.6%). Subperiosteal abscesses were detected in 3 patients and orbital abscesses in 7 patients. The patients were classified as those with preseptal and orbital cellulitis (Group I), and those with subperiosteal abscess (SPA) and orbital abscess (Group II). Proptosis, restricted eye movements and fever were found to be significantly higher in Group II (p <0.05). The mean abscess volume of the patients in Group II was found to be 3210±1614 mm³, and the mean value of proptosis was found to be 4.24±1.7 mm. Surgery was performed on 24 patients. The mean abscess volumes in the surgical group and the non-surgical group were found to be 3800 mm³ and 850 mm³, respectively (p=0.034). The mean proptosis values in the surgical group and the non-surgical group were 4.91 mm and 1.55 mm, respectively (p=0,036). Conclusion: Whether patients presenting with orbital complications should be treated conservatively or surgically remains a topic of debate in the current literature. In this discussion, it is important to predict which patients will progress to a subperiosteal or an orbital abscess. In our study, we found that proptosis, limited eye movements, and high fever (>37.5 °C) were associated with abscess development, and abscess volume and proptosis value were also important in terms of surgical necessity.