Vittal Nayak | K.S. Hedge Medical Academy Jayram Shetty | K.S. Hedge Medical Academy Vijay Pai | K.S. Hedge Medical Academy Vasanthi Bangera | K.S. Hedge Medical Academy Namitha Manohar | K.S. Hedge Medical Academy Ajith Adyanthaya | K.S. Hedge Medical Academy Harish Shetty | K.S. Hedge Medical Academy
The patient was started on intravenous Cephalexin 500 Mg IV bid, Intravenous Ciprofloxacin 200 Mg IV bid, Intravenous Metronidazole 500 Mg IV bid x 7 days followed by oral Cephalexin and oral Ciprofloxacin 500mg for 7 days.
Some improvement in proptosis, edema were noticed but not adequate.
The right orbital abscess was drained by passing a 22 gauge Venflon cannula into the orbit below the supraorbital foramen. Pus was noted in the cannula. The needle was removed and negative pressure was applied to the cannula which was still in place. 6 to 7 cc thick greenish pus was aspirated into the syringe. Pressure was applied on eyelids maintained for 5min. Proptosis considerably reduced. A tight bandage was applied on eye and patient was extubated. Systemic antibiotics and NSAID’s were continued for 5 days post operatively.
The gram stain and cultures were negative.
On the first post-operative day, exophthalmometry demonstrated 2 mm proptosis OD. Visual acuity was OD 6/9 OS 6/6. Extraocular movements improved markedly, but diplopia presisted on elevation. Pupil examination was normal. Fundus exam revealed marked reduction in choroidal folds.
At 15 days post op., the examination had returned to normal (Figure 3). The patient was asked to observe OD closely and report immediately if fever or proptosis recurred as the abscess wall was still in place. No surgical treatment was performed for the pansinusitis, however follow up was advised.