Subperiosteal orbital abscess in a 3-month-old infant: Navigating the balance between conservative and surgical intervention

Subperiosteal orbital abscess (SPOA) is a rare but serious complication of acute sinusitis in infancy. We report a 3-month-old male infant who presented with a two-day history of progressive left periorbital swelling and fever. Examination revealed left-sided proptosis, ptosis, chemosis, and restricted extraocular movements. Contrasted CT of the orbit and paranasal sinuses demonstrated a rim-enhancing medial subperiosteal orbital collection with irregularity of the lamina papyracea and a superotemporal extraconal collection. Initial intravenous antibiotic therapy, clinical improvement was limited. Subsequent MRI brain, orbit and paranasal sinus confirmed a medially located SPOA with superior extension. The patient underwent endoscopic sinus surgery and left orbital decompression, resulting in complete resolution of orbital swelling and restoration of normal ocular function. This case report further elucidates critical considerations in managing such cases in early infancy, emphasising the balance between medical therapy and timely surgical intervention to mitigate potentially serious complications.