Yulia Dian E, Mahyuddin Mutmainah, Alatas Sahar S S, Soeharto Diajeng A
Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
Int J Surg Case Rep. 2022 Jan;90:106737. doi: 10.1016/j.ijscr.2021.106737. Epub 2021 Dec 28.
Orbital cellulitis in children is a potentially fatal emergency and develops rapidly, leading to severe visual loss and life-threatening complications.
We report a case of a 16-month-old girl who presented to the emergency department unconscious with a four-day history of a swollen right eyelid. CT scan revealed soft tissue swelling at the superior and inferior palpebral region with bilateral maxillary sinusitis. She had a severe sepsis and received intravenous antibiotics. After her general condition improved, she underwent surgical drainage in conjunction with mini-FESS (functional endoscopic sinus surgery)-the culture of purulent material from which Staphylococcus Aureus was isolated. After a few days, she had hospital-acquired pneumonia, and an abscess in her right eyelid reformed. Immunoglobulin test and lymphocyte subset test was normal. The patient underwent re-surgical drainage and had complete resolution of refractory orbital cellulitis.
Severe refractory orbital cellulitis secondary to indolent infection is oftentimes found in immunocompromised patients or in those with underlying ocular diseases; our immunocompetent patient had a seemingly mild case of sinusitis which quickly progressed to severe orbital cellulitis. Oftentimes, broad-spectrum antibiotics are sufficient to treat orbital cellulitis, however, the same cannot be said for our patient, abscess reformed despite appropriate definitive antibiotic therapy in accordance with the culture results.
While the main treatment of orbital cellulitis is administration of antibiotics, in certain conditions as found in our patient, patients may not respond well to conservative treatment. Thus, close monitoring is essential, and any sign of progression warrants prompt surgical drainage.
儿童眼眶蜂窝织炎是一种潜在致命的急症，发展迅速，可导致严重视力丧失和危及生命的并发症。
我们报告一例16个月大女孩，因右眼睑肿胀4天，意识不清被送至急诊科。CT扫描显示上下睑区软组织肿胀并伴有双侧上颌窦炎。她患有严重脓毒症，接受了静脉抗生素治疗。在她的一般状况改善后，她接受了手术引流并结合微型功能性鼻内镜鼻窦手术（FESS）——从脓性物质培养物中分离出金黄色葡萄球菌。几天后，她发生了医院获得性肺炎，右眼睑又形成了脓肿。免疫球蛋白检测和淋巴细胞亚群检测均正常。患者接受了再次手术引流，难治性眼眶蜂窝织炎完全消退。
由隐匿性感染继发的严重难治性眼眶蜂窝织炎常见于免疫功能低下患者或患有基础眼部疾病的患者；我们这位免疫功能正常的患者起初看似患有轻度鼻窦炎，但很快进展为严重眼眶蜂窝织炎。通常，广谱抗生素足以治疗眼眶蜂窝织炎，然而，我们的患者情况并非如此，尽管根据培养结果给予了适当的确定性抗生素治疗，脓肿仍复发了。
虽然眼眶蜂窝织炎的主要治疗方法是使用抗生素，但在我们患者这种特定情况下，患者可能对保守治疗反应不佳。因此，密切监测至关重要，任何病情进展迹象都需要及时进行手术引流。
