Dangers Lurking Around the Eye

This little 6yr old girl with recent history of URTI was quickly followed with eye swelling up. He photo shows her at presentation (Above) and after treatment -both surgical and medical treatment. (Below)

The CT scans which confirmed the clinical findings.

The dotted red circle showing a sub-periosteal abscess entering the orbit(eye socket). 

Hospital admission and IV antibiotics didn’t reduce the abscess and therefore we had to proceed with medial  orbitotomy via transcaruncular incision and drainage of abscess while the Rhinology team performed a limited Functional Endoscopic Sinus Surgery (FESS) to drain multiple sinuses full of mucopus. Below is the collage of the surgery. (viewer discretion advised)

Eye is surrounded by the Para-nasal sinuses. In children, the sinuses are small and they increase in size as the child grows. Children are vulnerable to sinus infections as a consequence of upper respiratory tract infections reducing the ciliary clearance from the sinuses and fluid stasis. Sinus infections in turn can be dangerous to the eyes as the distance between sinuses and eye is very small in children especially the medial walls of the orbits which is paper thin aptly named- lamina paprycea. 

Once the infection reaches the eye socket (orbit), it can quickly escalate to involving the orbital fat, various nerves and muscles within the eye socket including the optic nerve. Pus can collect in the form of an abscess adjacent to the eyeball (globe) push it forward. The threshold for intervention is very low in the case of small children. 

Published by Dr. Raghuraj Hegde

Free thinker| Poet| Writer| Traveller| Doctor| Ophthalmic Plastic Surgeon

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