J Korean Ophthalmol Soc.  2012 Oct;53(10):1523-1527.

A Case of Orbital Abscess with Central Retinal Artery Occlusion

• Kim YS
• Baek SK
• Ha MS

Abstract

PURPOSE
To report a case of rapidly progressed orbital abscess after central retinal artery occlusion.
CASE SUMMARY
A 60-year-old man with right periorbital pain and edema starting 3 days earlier visited the hospital. His first visual acuity was 1.0 for the right eye with peripheral edema and tenderness; severe hemorrhagic chemosis, proptosis (approximately 3 mm) and extraocular motility limitation were also observed. According to the CT findings, a 2.5 x 1 cm-sized encapsulated cystic mass was found in the right orbital cavity, along the medial orbital wall; with a diagnosis of orbital abscess, he was hospitalized with systemic antibiotic treatment and abscess drainage. On the second day of hospitalization, the best corrected visual acuity was reduced to light perception, and relative afferent pupillary defect, pale retina and cherry red spot were found. Therefore, emergent incisional drainage, optic massage, and antibiotics were given to the patient. Immediately after the surgery, the peripheral edema and proptosis improved; nevertheless, central retinal artery occlusion did not resolve and vision did not improve. Two months later, best corrected visual acuity for the right eye was counting fingers and central retinal artery occlusion showed no further improvement.
CONCLUSIONS
No case report on rapidly progressing orbital abscess has been proposed in Korea to date. In the case of rapidly progressed orbital abscess, incisional drainage and antibiotics should be administered promptly.

Keyword

Central retinal artery occlusion; Orbital abscess

MeSH Terms

Abscess
Anti-Bacterial Agents
Drainage
Edema
Exophthalmos
Eye
Fingers
Hospitalization
Humans
Korea
Light
Massage
Middle Aged
Orbit
Prunus
Pupil Disorders
Retina
Retinal Artery
Retinal Artery Occlusion
Vision, Ocular
Visual Acuity
Anti-Bacterial Agents

Figure

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  Figure 1 External photograph demonstrates severe lid swelling, erythema and hemorrhagic chemosis at admission.

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  Figure 2 CT scans demonstrate inferolateral displacement of the right eyeball by an orbital abscess (35 × 10 mm) that extends along the medial orbital wall (HD #1). Mild right ethmoiditis and no evidence of carvenous sinus thrombosis.

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  Figure 3 Fundus photograph shows some retinal hemorrhage and retinal edema with cherry-red spot in the right eye (HD #2).

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  Figure 4 Fundus photograph and OCT show consistent retinal hemorrhage with cherry-red spot and retinal edema (POD #11).

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  Figure 5 Fluorescein angiographs show delayed arterial filling in the right eye (POD #11).

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  Figure 6 The patient 11 days after the operation. Decreased lid swelling and proptosis, but remained exodeviation of right eye (A). The patient 2 months 11 days after the operation. No lid swelling or proptosis (B).

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