5.1 Patient History Leading to the Specific Problem

The patient is a 28-year-old woman with a history of progressive, tender swelling of the right upper and lower eyelids for the last 3 days (Fig. 5-1). She has a low-grade fever and feels ill. The week prior to presentation she had an upper respiratory tract infection that cleared with no treatment. She complains of decreased vision in the right eye and double vision.

5.2 Anatomic Description of the Patient’s Current Status

Examination reveals firm, warm swelling of the right upper and lower eyelids and moderate proptosis. The visual acuity is 20/60 on the right and 20/20 on the left. The extraocular movements of the right eye are diffusely restricted in all directions. Pupils and dilated retinal examination are normal. A complete blood count (CBC) shows a polymorphonuclear leukocytosis. A computed tomography (CT) scan performed on the day of presentation shows opacification of the right ethmoid sinuses and an abscess along the roof of the right orbit (Fig. 5-2). Examination of the left eye is normal. The diagnosis is right orbital cellulitis and abscess secondary to previous upper respiratory tract infection.

5.3 Recommended Solution to the Problem

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  Begin broad-spectrum intravenous antibiotics.

  
  
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  Perform an anterior orbitotomy to drain the orbital abscess and obtain a specimen for culture and sensitivity.

  
  
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  Otolaryngology performs an ethmoidectomy to drain the affected sinuses.

  
  
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  Continue oral antibiotics for 10 days to 2 weeks after discharge from the hospital.

5.4 Technique

A variety of incisions are possible for access to the orbit (Fig. 5-3a). Selection depends on the location of the abscess. In this case, we chose an incision located in the inferior edge of the right eyebrow to provide easy access to the soft tissues of the right orbit and moderate amount of pus was drained (Fig. 5-3b). After drainage of the abscess and irrigation of the wound, a drain is placed to be removed in 3 days (Fig. 5-3c). Otolaryngology performed an endoscopic ethmoidectomy at the same time.