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Anaïs Carniciu, Ilya Leskov, Jonathan Chou, Suzanne K. Freitag; Clinical presentation and bacteriology of eyebrow infections: the Massachusetts Eye and Ear experience (2008-2015). Invest. Ophthalmol. Vis. Sci. 2016;57(12):691.
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© ARVO (1962-2015); The Authors (2016-present)
Characterization of preseptal cellulitis and abscesses of the eyebrow remains limited. A retrospective study was performed to elucidate the clinical history, precipitating human behaviors, and bacteriology of eyebrow infections.
A retrospective chart review was conducted to identify patients with preseptal cellulitis or abscess involving the eyebrow who were treated at Massachusetts Eye and Ear Infirmary between 2008 and 2015. Patient history, ophthalmic examination, and culture results were reviewed to identify characteristics and trends in the clinical presentation and bacteriology of eyebrow infections.
80 patients with eyebrow infections were identified. The median age of patients was 37 years (range 14-67). 49 patients (61.3%) were female, and 31 (38.7%) were male. Of all eyebrow infections, 26 cases (32.5%) were limited to preseptal cellulitis without abscess formation, while the remaining 54 cases (67.5%) presented with eyebrow abscess. Of cases presenting with abscess, 20 were positive for methicillin-resistant Staphylococcus aureus (MRSA); this comprised 39.2% of all culture results. Twelve cases had cultures positive for methicillin-sensitive Staphylococcus aureus (MSSA), which comprised 23.5% of all culture results. Coagulase negative staphylococci (CoNS) were present in 7 eyebrow abscesses, corresponding to 13.7% of culture results. Three patients had a medical history of previous MRSA infection, while 4 patients had prior history of recurrent skin infections (with organisms unknown) elsewhere in the body. Two patients presented with recurrent eyebrow abscess after previous incision and draining. Clinical history was remarkable for eyebrow hair removal (tweezing, waxing, threading, or shaving) in 17 cases (21.3%), manipulation of acne lesions (“popping,” “picking,” or “squeezing”) in 6 cases (7.5%), and both brow hair removal and acne manipulation in 1 case (1.3%).
The most frequently isolated organisms in eyebrow infections are MRSA, MSSA, and CoNS, respectively. Human behaviors associated with presentation of preseptal cellulitis and abscesses of the eyebrow include eyebrow hair removal and manual manipulation of eyebrow-localized acne lesions. Given the prevalence of MRSA in the bacteriology of eyebrow infections, empiric antibiotic coverage for MRSA should be strongly considered in any patient with an eyebrow area infection.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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