Sears J M, Gabriel H M, Veith J
Illinois College of Optometry, Chicago, USA.
J Am Optom Assoc. 1999 Oct;70(10):661-5.
Preseptal cellulitis is a serious ocular condition that--if left untreated--has the potential to cross the septal barrier, spread to the posterior orbit, and may result in fatal complications. Because it is difficult to determine the pathogen responsible for any cellulitis without aspirating a culture sample, treatment is usually instituted by an assumption of the most common causative organisms, Staphylococcus or Streptococcus.
A 42-year-old black woman manifested signs and symptoms consistent with right preseptal cellulitis. Throughout treatment, visual acuity remained 20/20 for both eyes, extraocular muscles were unrestricted without pain, and anterior globe structures were clear. The patient was started on a regimen of 250-mg oral dicloxacillin four times a day. When no response was seen at 36 hours, the patient was changed to 500-mg oral ciprofloxacin every 12 hours. She responded to the 500-mg ciprofloxacin and recovered with no sequelae. An abscess, which had formed during the cellulitis, self expressed and this material was cultured. The cultures identified the responsible organism as Proteus species, an unexpected pathogen in a well-groomed patient.
This case demonstrates the need to consider alternate pathogens when treating preseptal cellulitis, change medications accordingly, and consider alternate treatments as needed.
眶隔前蜂窝织炎是一种严重的眼部疾病，若不治疗，有可能穿过眶隔屏障，蔓延至眶后，可能导致致命并发症。由于不抽吸培养样本就难以确定引起任何蜂窝织炎的病原体，治疗通常基于对最常见病原体葡萄球菌或链球菌的假设进行。
一名42岁黑人女性出现了与右侧眶隔前蜂窝织炎相符的体征和症状。在整个治疗过程中，双眼视力均保持在20/20，眼外肌不受限且无疼痛，眼球前部结构清晰。患者开始接受每日4次、每次250毫克口服双氯西林的治疗方案。36小时后未见反应，患者改为每12小时口服500毫克环丙沙星。她对500毫克环丙沙星有反应并康复，无后遗症。蜂窝织炎期间形成的一个脓肿自行破溃，对排出物进行了培养。培养结果确定病原体为变形杆菌属，这在一名生活讲究的患者中是一种意想不到的病原体。
本病例表明，治疗眶隔前蜂窝织炎时需要考虑其他病原体，相应地更换药物，并根据需要考虑其他治疗方法。
