Abstract
Purpose: :
To discuss the diagnosis, management and outcome of preseptal abscess with an atypical occurrence.
Methods: :
A 50 years old caucasian male referred to our ward for the presence of tender, swollen and erithematous skin of the periorbital region arose 4 days before. The patient told that the symptoms started with the presence of a foruncle in the inner terminal of the eyebrow. The patient reported the insurgence of pain in the frontal and orbital region six hours after having manipulated the foruncle. At the presentation the patient showed with fever, 38 °C, persistent pain in the orbital region which was exacerbated by eye movement. The skin of the orbital region was tender, swollen and erithematous. The patient was tearing with conjunctival and episcleral injection; the visual acuity, ocular motility, pupillary reflex and lacrimal outflow pathways were normal. The patient underwent to otorhynolaryngological visit which showed the presence of an altered morphology of the nasal septum and purulent secretion in the medium meatus. The CT scan of the orbit showed the presence of soft tissues hyperdensity in the left zygomatic region extending superiorly up to the lids and to the nasal bridge region. Furthermore, a thickening of the Tenone’s capsule was observed. The patient undergo to treatment with systemic intramuscular ceftazydime pentahydrate 1 g b.i.d. and methylprednisone 4 mg b.i.d. for 7 days and topical tobramicyne and dexamethasone ointment and eyedrops q.i.d. for seven days. After this period of treatment the patient achieved a complete recovery.
Conclusions: :
The present case is reported to underline the possible diffusion of skin infection of the periorbital region to the preseptal tissues, also involving ocular tissues such as the Tenon’s capsule. The institution of appropriate diagnostic imaging, and prompt medical treatment are useful for a favourable outcome.
Keywords: inflammation • orbit • anatomy