【摘要】 骨膜下脓肿是眼眶蜂窝织炎的一种，以脓和渗出液汇集在眼眶内骨膜下为特点。对于新生儿，眼眶脓肿非常罕见。我们报告1例年龄为26d的右眼患有严重眼眶蜂窝织炎的女患儿。眼眶和副鼻窦CT扫描显示右眼眶蜂窝织炎并内侧骨膜下和眼眶后部脓肿。眼分泌物培养见葡萄球菌生长，经用先锋霉素和甲硝唑静脉注射和经内窥镜鼻窦手术行急诊脓肿引流，恢复良好。 通过内窥镜的鼻窦引流手术是预防更严重的并发症的首选治疗。
【关键词】 眼眶脓肿 筛窦炎 新生儿 经内窥镜鼻窦手术
INTRODUCTION
A subperiosteal abscess is a form of orbital cellulitis characterized by a collection of fluid and pus confined by the periosteal lining of the orbit[1]. Subperiosteal abscess may result from orbital cellulitis secondary to sinusitis. The condition may cause significant morbidity to the vision, and even devastating complications such as cavernous sinus thrombosis, cerebritis and brain abscess[15]. In neonates, orbital abscesses caused by ethmoiditis are rare. We reported a case of orbital cellulitis with subperiosteal abscess in a 26dayold baby girl. She recovered well after intravenous antibiotics and surgical drainage.
CASE REPORT
A 26dayold baby girl presented with 2day history of right eyelid swelling. The swelling progressed very fast within 2 days. It extended to the surrounding periorbital region, face, right ear and nose. It was associated with right eye redness and purulent discharge. There was also discharge from the nose. The baby had history of highgrade fever and running nose four days prior to the presentation. However, there was no history of cough, shortness of breath, vomiting or fits. There was no history of trauma. The baby was feeding well and active. She was delivered full term via spontaneous vaginal delivery. There was no eye discharge noted after delivery. Antenatal history was uneventful.
On examination the baby was febrile. The right eye was swollen and proptosed (Figure 1). The swelling extended to the right face, ear and nose. The overlying skin was warm and tender. There was no obvious squint noted. However, the right eye motility was impaired. The conjunctiva was injected and chemosed with presence of purulent discharge. The cornea was clear and the anterior chamber was quiet. The pupil was round and reactive. There was no relative afferent pupillary defect (RAPD) detected. Funduscopy showed slight hyperemic swollen disc. The macula and the retina were normal. Examination of the left eye revealed normal anterior segment and posterior segment with good motility. Systemic examinations were unremarkable.
Clinically the patient was diagnosed to have right severe orbital cellulitis. An urgent computed tomography (CT) scan of the orbits and paranasal sinuses was performed. The CT scan showed proptosis of the right eye with a huge abscess at medial aspect of the right globe causing displacement of medial rectus. The abscess extended laterally into intracranial region behind the globe, and medially to ethmoidal sinuses and also nasal cavity(Figure 2). The right optic nerve also appeared thickening with irregular margin. However, the left eye appeared normal.
Blood investigations showed raised total white blood cell count (22.9×109) with neutrophilia (40%). The hemoglobin and platelet count were within normal limit. The eye discharge culture showed the growth of Staphylococcus aureus.
However, the blood culture revealed no growth. Patient was started on intravenous ceftriaxone 200mg daily and intravenous metronidazole 30mg three times per day.
An emergency drainage of the abscess was performed via functional endoscopic sinus surgery(FESS). Intraoperatively, there were few of the findings noted. The right nostril was filled with mucoid discharge and pus. The middle and inferior turbinates were congested. The pus discharge was also noted coming from right osteomeatal complex. The pus was drained via endoscopic procedure. On top of that a small fistula was seen at the medial aspect of the right conjunctiva. A small incision was made at subconjunctiva region and the pus was drained out. The pus was sent for culture and grew Staphylococcus aureus. The organism was sensitive to both antibiotics given.
Patient improved dramatically after the surgery. The right orbital swelling subsided and she was able to move the right eye partially(Figure 3). There was only slight restriction of the medial and superior gaze. She was discharged well after completion of the antibiotics course. On followup at the clinic, her condition was good. There was no more proptosis and she regained her full ocular motility.
[1] [2] 下一页 |
