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Kim, Baek, and Ha: A Case of Orbital Abscess with Central Retinal Artery Occlusion
Case Report
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(10): 1523-1527.

Published online: 17 October 2012

DOI: https://doi.org/10.3341/jkos.2012.53.10.1523

A Case of Orbital Abscess with Central Retinal Artery Occlusion

Young Seung Kim, MD, Seung Kook Baek, MD, Myung Sook Ha, MD

Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea.

Address reprint requests to Myung Sook Ha, MD. Department of Ophthalmology, Konyang University Hospital, #158 Gwanjeodong-ro, Seo-gu, Daejeon 302-241, Korea. Tel: 82-42-600-9258, Fax: 82-42-600-9176, hmseye@hanmail.net

Received 12 December 2011       Accepted 5 August 2012

Copyright © 2012 The Korean Ophthalmological Society

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 × 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.

Keywords: Central retinal artery occlusion, Orbital abscess

Figures and Tables

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).
jkos-53-1523-g006

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