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A 39-year-old man with painful proptosis after dental extraction
Digital Journal of Ophthalmology 2008
Volume 14, Number 4
February 7, 2008
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Brett Kotlus | Allure Medical Spa
Veena Kumar | Maxwell Aesthetic Surgery
Robert Cravens | Tucson Ear Nose and Throat
Robert Dryden | Arizona Centre Plastic Surgery
Treatment
Endoscopic left middle meatal antrostomy and complete ethmoidectomy was performed. Lateral orbitotomy with osteotomy was also performed and an intraconal collection of foul-smelling, purulent fluid containing gas bubbles was encountered . This material was evacuated, intraoperative cultures were obtained, and a surgical drain was placed. Intravenous ampicillin sodium/sulbactam sodium (Unasyn, Pfizer, NY, NY) was administered postoperatively.

Microbiologic cultures obtained intraoperatively revealed growth of group F Streptococcus, coagulase negative Staphylococcus, and mixed anaerobic flora.

Four days after surgical intervention, the patient’s visual acuity in the left eye was 20/30, no afferent pupillary defect was evident, the periorbital edema and proptosis had significantly improved, and motility was nearly full.
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Figure 4
Intraoperative photograph demonstrating a purulent orbital fluid collection with surfacing gas bubbles.