Abstract
Purpose
To report a case of sudden orbital cellulitis presenting 2 weeks after strabismus surgery in a patient who had pre-viously undergone retinal surgery for rhegmatogenous retinal detachment.
Case summary
A 45-year-old male visited the ophthalmology clinic with a 3-day history of left eye pain and lid swelling which suddenly developed 2 weeks after left lateral rectus muscle recession surgery for secondary sensory exotropia. The patient had undergone trans pars plana vitrectomy twice, scleral encircling, oil injection and removal for rhegmatogenous retinal detachment 1.3 years prior. His best corrected visual acuity was 0.2 in his left eye and physical examination re-vealed eyelid edema, chemosis, and subconjunctival hemorrhage of the left eye. The next day, eye movements were mod-erately restricted. Computed tomography scanning with contrast enhancement demonstrated diffuse periorbital soft tissue swelling and enhanced fat stranding suggesting left orbital cellulitis. The patient was hospitalized with intravenous broad spectrum antibiotics. He was discharged after a 5-day course of intravenous antibiotic treatment, but readmitted for symp-tom aggravation and purulent discharge from the left conjunctival fornix. Culture of conjunctival fornices revealed pen-icillin-resistant staphylococcus aureus. Intravenous anitibiotics were maintained for 11 days additionally and left eye swel-ling, tenderness and ocular movement restrictions were improved. The patient was discharged from the hospital with a best corrected visual acuity of 0.2.
References
2. Tovilla-Canales JL, Nava A, Tovilla y, Pomar JL. Orbital and peri-orbital infections. Curr Opin Ophthalmol. 2001; 12:335–41.
3. Kivlin JD, Wilson ME Jr. Periocular infection after strabismus surgery. The Periocular Infection Study Group. J Pediatr Ophthalmol Strabismus. 1995; 32:42–9.
4. Georgakopoulos CD, Eliopoulou MI, Stasinos S, et al. Periorbital and orbital cellulitis: a 10-year review of hospitalized children. Eur J Ophthalmol. 2010; 20:1066–72.
5. Moubayed SP, Vu TT, Quach C, Daniel SJ. Periorbital cellulitis in the pediatric population: clinical features and management of 117 cases. J Otolaryngol Head Neck Surg. 2011; 40:266–70.
6. Weakley DR. Orbital cellulitis complicating strabismus surgery: a case report and review of the literature. Ann Ophthalmol. 1991; 23:454–7.
7. Bertino JS Jr. Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics. Clin Ophthalmol. 2009; 3:507–21.
8. Emmett Hurley P, Harris GJ. Subperiosteal abscess of the orbit: du-ration of intravenous antibiotic therapy in nonsurgical cases. Ophthal Plast Reconstr Surg. 2012; 28:22–6.
9. Yang M, Quah BL, Seah LL, Looi A. Orbital cellulitis in chil-dren-medical treatment versus surgical management. Orbit. 2009; 28:124–36.
11. Armesto A, Ugrin MC. Orbital cellulitis after faden operation on the medial rectus. Strabismus. 2007; 15:215–9.
12. Basheikh A, Superstein R. A child with bilateral orbital cellulitis one day after strabismus surgery. J AAPOS. 2009; 13:488–90.
13. Hoyama E, Limawararut V, Leibovitch I, et al. Blinding orbital cel-lulitis: a complication of strabismus surgery. Ophthal Plast Reconstr Surg. 2006; 22:472–3.
14. Palamar M, Uretmen O, Kose S. Orbital cellulitis after strabismus surgery. J AAPOS. 2005; 9:602–3.
15. Lau FH, Leung TF, Fan DS. An unusual complication after stra-bismus surgery. Hong Kong Med J. 2009; 15:297–8.
16. Lee SB, Lee NH, Lee YH, Jo YJ. Late complications after success-ful scleral buckling surgery using hydrogel buckles. J Korean Ophthalmol Soc. 2006; 47:512–8.
17. Whitcher JP. Ocular infections--a rational approach to antibiotic therapy. West J Med. 1994; 161:615–7.