Cardinal Santos Medical Center, Philippines
Title: Orbital Cellulitis Presenting as Proptosis in an 8-Year old male
Biography: Patricia L. Lee
An 8-year old male presented with sudden-onset proptosis and decreased vision in the left eye. Magnetic resonance imaging done showed a left-sided subperiosteal ethmoidal abscess associated with maxillary sinusitis. The patient was started on empiric intravitreal antibiotics with no improvement in symptoms. He subsequently underwent surgical drainage through a combined external Lynch and internal transnasal endoscopic sinus approach. Cultures of collected purulent material revealed normal orbital flora and p. pneumotropica in the maxillary sinus. Antibiotics were shifted accordinlgy. On the fourth post-operative day, proptosis had resolved and vision had improved.
At least 10% of all orbital cellulitis cases are complicated by the presence of orbital or subperiosteal abscesses. While current practice recommends close observation and intravenous antibiotics only in children under 9 years of age with small to moderately-sized abscesses and no intracranial or dental involvement, individualized treatment is important. Prompt imaging and a discerning clinical eye are thus central in guiding treatment, particularly in patients who require surgical intervention.