Pediatric lateral retro-orbital abscess: a novel endoscopic drainage approach

Abstract

Author(s): Abdullah Musleh*

A 12-year-old boy was first reported to the clinic with a complaint of a swollen right eye and impaired vision. On examination, the symptoms observed are progressive swelling, redness, photophobia, decreased vision, and restricted right eye movement. Further, the patient showed right periorbital swelling with proptosis with severe restriction on proper eye movement. Additionally, the visual acuity was significantly diminished (6/12), even though the Pupil was reactive to light. A computerized tomography (CT) scan with contrast showed a retro-orbital abscess with ring enhancement (3 cm × 2 cm), mainly towards the inferolateral aspect of the right orbit. Further, the CT scan results also revealed complete opacification of the right maxillary, anterior and posterior ethmoid paranasal sinuses. In this patient, we performed an endoscopic middle meatal antrostomy to clear the maxillary sinus in addition to Anterior and Posterior ethmoidectomies. Specifically, the lamina papyracea was partially removed to decompress the orbit and drain the pus from the orbital abscess. Using this technique, we got maximum drainage of pus, which helped to decompress the orbit and restore the vision in the patient's right eye. Also, the endoscopic drainage of pus could help the antibiotic treatment. The patient's health improved gradually with the orbit size reaching normal size and function in 5 days after antibiotic treatment. Overall, this report presents a novel endoscopic approach for draining the retro-orbital abscess, and this approach could be used to treat patients with orbital cellulitis and abscess. What makes this case unique is that in most of the cases in the literature, the endoscopic approach was successful when the abscess is localised in the medial aspect of the orbit, not in the inferolateral aspect like this case.

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