Pedrosa Raul Calaça da Costa, Pimenta Guilherme Mendes, Valletta Raíssa Camelo, Jordão Nathalya Ducarmo, Santos Felipe Macedo, de Camargo Leandro Azevedo, Avelino Melissa Ameloti Gomes
Head and Neck Unit, Department of Surgery, Clinical Hospital, Federal University of Goiás (HC-UFG), Goiânia, GO, Brazil.
Department of Radiology, Clinical Hospital, Federal University of Goiás (HC-UFG), Goiânia, GO, Brazil.
Am J Case Rep. 2021 May 12;22:e930808. doi: 10.12659/AJCR.930808.
BACKGROUND Periorbital abscesses are uncommon complications of acute bacterial rhinosinusitis; with the evolution of diagnostic and therapeutic methods, it is rare that the patient progresses to irreversible blindness. Central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) rarely occur simultaneously and the factors that influence this occurrence are not well understood. CASE REPORT This is a case report of an immunocompetent healthy adolescent girl, who developed irreversible blindness caused by a periorbital abscess secondary to acute bacterial rhinosinusitis due to CRAO and CRVO. Despite 6 days of clinical treatment, including intravenous antibiotics (vancomycin-associated piperacillin with tazobactam), she had a large periorbital abscess and could not open her left eye. Therefore, she was transferred to a tertiary hospital; 1 day after her admission, she underwent surgical treatment to drain the abscess through external and endoscopic access. In addition, she received broad-spectrum antibiotics (meropenem with vancomycin) for 3 weeks. She was no longer able to perceive light with the left eye, despite her clinical improvement. This case report discusses the factors that could have contributed to this poor outcome, despite clinical and surgical treatment. CONCLUSIONS We conclude that there are several mechanisms that can lead to the loss of vision and when the indicated surgical intervention is delayed, it can increase the risk of visual sequelae.
眶周脓肿是急性细菌性鼻窦炎罕见的并发症；随着诊断和治疗方法的发展，患者进展至不可逆失明的情况已较为罕见。视网膜中央动脉阻塞（CRAO）和视网膜中央静脉阻塞（CRVO）很少同时发生，且影响其发生的因素尚不清楚。病例报告：本文报告一例免疫功能正常的健康青春期女孩，因急性细菌性鼻窦炎继发眶周脓肿，导致CRAO和CRVO，进而发展为不可逆失明。尽管进行了6天的临床治疗，包括静脉使用抗生素（万古霉素联合哌拉西林他唑巴坦），但她仍有一个较大的眶周脓肿，左眼无法睁开。因此，她被转至一家三级医院；入院1天后，她接受了手术治疗，通过外部和内镜途径引流脓肿。此外，她接受了3周的广谱抗生素（美罗培南联合万古霉素）治疗。尽管临床症状有所改善，但她的左眼已无法感知光线。本病例报告讨论了尽管进行了临床和手术治疗，但仍导致这一不良结局的可能因素。结论：我们得出结论，有多种机制可导致视力丧失，而当延迟进行指定的手术干预时，会增加出现视觉后遗症的风险。
