Medical management alone may be adeguate for treating OC, especially in children younger than 9 years or those presenting with no or only small subperiosteal abscesses (R ferences 69, 72). Evaluation for surgical intervention is indicated in patients with significant visual impairment; frontal sinus or pansinusitis; defined abscesses; prominent mass effect; gas in the orbit; ophthalmoplegia; or lack of clinical improvement despite adequate parenteral therapy