Orbital Infection With Intracranial Involvement

Abstract

A 9-year-old boy presented with 4 days of painful right eye swelling (Fig 1). He had fever and leukocytosis without focal neurological findings. Imaging revealed pansinusitis with superior orbital wall subperiosteal abscess and frontoparietal subdural empyema. The patient had three serial washout operations with ophthalmology, otolaryngology, and neurosurgery (Fig 2) and four weeks of tailored intravenous antibiotics for cultures positive for group C streptococcus, Streptococcus constellatus, Hemophilus influenza, and Prevotella. He recovered fully. Orbital cellulitis (postseptal cellulitis) typically arises in conjunction with acute rhinosinusitis. It is potentially lifethreatening in the setting of intracranial involvement. Intracranial complications include epidural abscess, subdural empyema, meningitis, encephalitis, and dural sinus thrombophlebitis. Infection can propagate by septic thromboembolism or direct extension through diploic