A Teenager With Right-Eye Swelling

Honey H. Herce, MD; Kimberly G. Yen, MD


August 07, 2014

Case Diagnosis

The presence of the intraorbital abscess with concomitant sinus disease is most likely related to orbital cellulitis. It is important to ascertain any history of trauma because that can predispose the patient to retrobulbar hemorrhages, which can also present with similar proptosis and ophthalmoplegia.

Rhabdomyosarcoma is the most common soft-tissue sarcoma in children, usually occurring at 8-10 years of age. It can present with acute eyelid swelling, ecchymosis, and proptosis.

Clinical Course

The patient was started on broad-spectrum antibiotics: clindamycin, cefotaxime, and intravenous vancomycin. He underwent an anterior orbitotomy with drainage of the abscess on the right side, as well as a right frontal sinusotomy and anterior ethmoidectomy performed by the otolaryngology service.

He was monitored closely and was found to have a superior ophthalmic vein thrombosis and incomplete resolution of the intraorbital abscess on repeat imaging. He underwent a second anterior orbitotomy combined with endoscopic sinus drainage by otolaryngology.

Wound cultures from both procedures were found to have multiple organisms, including Staphylococcus epidermidis, Staphylococcus lugdunensis, and Streptococcus constellatus. He was treated with intravenous antibiotics for 3 weeks because of concern about meningeal enhancement on initial MRI. He had marked improvement clinically after the second drainage, with improvement of the superior ophthalmic vein thrombosis on repeat imaging.


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