Elderly Woman with Headache and Lagophthalmos with Visual Loss
Utaro Anazawa1, Kazuhiro Omura1,2* and Yasuhiro Tanaka1
1Department of Otorhinolaryngology, Dokkyo Medical University Koshigaya Hospital, Japan
2Department of Otorhinolaryngology, The Jikei University School of Medicine, Japan
Submission: November 17, 2017; Published: December 09, 2017
*Corresponding author: Kazuhiro Omura, Postal code: 343-0845, 2-1-50 Minamikoshigaya Koshigaya-si, Saitama, Japan, Tel: +81-48-965-1111; Email: kazuhiro.omura@gmail.com
How to cite this article: Utaro A, Kazuhiro O, Yasuhiro T.Elderly Woman with Headache and Lagophthalmos with Visual Loss. JOJ Ophthal. 2017; 5(5): 555674. DOI: 10.19080/JOJO.2017.05.555674.
Introduction
A 78-year-old woman presented with headache, a six-day history of swollen right eye, and a four-day history of gradually worsening visual disturbance, along with spontaneous vomiting. A physical examination showed severe swelling of her right eye with inflammation and severe edema of the conjunctiva, lagophthalmos, cataract ulceration, and exophthalmic ophthalmoplegia (Figure 1A & 1B). A visual accuracy test could not be performed. Computed tomography revealed a superior subperiosteal orbital abscess with the right eye protruding1.8 cm anterior to the left eye (Figure 2A & 2B).
Diagnosis
A superior subperiosteal orbital abscess (SSPOA) is a collection of purulent material between the periorbit and the superior bony orbital wall, and is typically a complication of frontal sinusitis. Orbital complications can result in permanent blindness or death if not treated promptly and appropriately. Immediate attention and proper management are required to prevent fatal complications [1]. Abscesses in older patients usually contain mixtures of aerobic and anaerobic microbes and are more likely to require drainage than those in children. Surgical drainage is particularly recommended for SSPOAsbecause of the risk of intracranial infection [2]. The visual loss associated with orbital cellulitis is thought to result from optic neuritis as a result of inflammation from nearby infection, ischemia resulting from thrombophlebitis along the orbital veins, and pressure resulting in central retinal artery occlusion [3].
The patient underwent emergent surgical drainage with combined approach. The inflammation improved immediately postoperatively, but she did not regain vision in her right eye.
Conflict of Interest
The authors confirm no relevant conflicts of interest to this work, and no relevant financial disclosures to report.
References
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