BILATERAL ORBITAL ABSCESS WITH BILATERAL

SEPTIC CAVERNOUS SINUS THROMBOSIS

IRAWADI PUTRA, GETRY SUKMAWATI,
Department of Ophthalmology, Infection and Immunology Subdivision
Faculty of Medicine, Andalas University, M. Djamil Hospital,
Padang, West Sumatera
INTRODUCTION
Bilateral Orbital Abscess with bilateral septic Cavernous Sinus Thrombosis (CST) is a rare yet potentially fatal and
debilitating condition which important to diagnose earlier. With one of the complication of CST is decreased
visual acuity, opthalmoplegia, Optic Atrophy, periorbital sensory alteration secondary to damaged of trigeminal
nerve (CNV), and moreover mortality.
OBJECTIVE
To report a case of a child with bilateral Orbital Abscess with bilateral septic CST due to abscesses on tip of the
nose complications.
CASE REPORT
26 February 2013, an 18 month child was consulted from a Pediatrician. Was previously consulted to an
Otorhinolaryngologist, with findings abscess on tip of the nose, destruction the nasal septum, and Purulent
Meningitis. Culture shown Staphylococcus aureus. Level of consciousness was Glasgow Coma Scale (GCS) 10.
There was bilateral proptosis with severe eyelid swelling, conjunctival chemosis and injection, and normal
anterior segment. CT-Scan revealed bilateral Orbital Abscess and suspect of
Nasal Septum Abscess. We diagnosed him with bilateral Orbital Abscess and
bilateral septic CST. Patient had been previously received treatments of
Ampicillin, Chloramphenicol, and Metronidazole but condition worsen. We
recommended to give eye lubrication, Intravenous Meropenem, Vancomycin,
and Metronidazole immediately for 4 weeks.

In the first week patient had good consciousness, proptosis decreased, able to take objects, and observe using
the left eye. In the four weeks, total regression of the symptoms. Last condition the patient can move and
walking to something desirable. There was good ocular movement, but optic atrophy in right eye.
CONCLUSION
Early diagnosis is very important and Broad-spectrum intravenous antibiotics are the mainstay of treatment to
reduce morbidity and mortality. Optic atrophy is one of CST complication.
KEYWORD
Orbital abscess, CST, ocular movement, Optic atrophy
REFERENCES
Garcia GH, Harris GJ (2000). "Criteria for nonsurgical management of subperiosteal abscess of the orbit: analysis of outcomes". Ophthalmology 107 (8).
Ferguson MP, McNabb AA (1999). "Current treatment and outcome in orbital cellulitis". Australian and New Zealand Journal of Ophthalmology 27 (6): 375379.
Noel LP, Clarke WN, MacDonald N (1990). "Clinical management of orbital cellulitis in children". Canadian Journal of Ophthalmology 25 (1): 1116.
Shapiro E, Wald E, Brozanski B (1982). "Periorbital cellulitis and paranasal sinusitis: a reappraisal". Pediatric Infectious Disease 1 (2).
Westfall CT, Baker AS, Shore JW. Infectious diseases of the orbit. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. Philadelphia: W.B. Saunders,
2000: 3121-3129.
Gamble RC. Acute inflammations of the orbit in children. Arch Ophthalmol 1933; 10: 483-497.
Donahue SP, Schwartz G. Preseptal and orbital cellulitis in childhood. Ophthalmology 1998; 105: 1902-1906.
Smith TF, ODay D, Wright PF. Clinical implications of preseptal (periorbital) cellulitis in childhood. Pediatrics 1978; 62: 1006-1009.