Unilateral Ptosis Secondary to Pansinusitis in a Pediatric Patient: A Case Report

Abstract

Introduction: Ptosis or the dropping of an eyelid can affect both the adult and pediatric populations and can be caused by various factors. Ptosis is not very common and in children, the common causes include orbital cellulitis, congenital ptosis, Cranial Nerve III palsy, and Horner’s syndrome. However, unilateral acute ptosis from an infectious disease process is rare and there are only a few documented cases of such occurrences. Acute ptosis is a medical emergency and prompt diagnosis, and management is critical for the resolution of symptoms and prevention of serious complications. Case: We present an interesting case of a 14-year-old female with pansinusitis who experienced unilateral left-sided ptosis. Initially prescribed oral antibiotics for sinusitis, the patient developed ptosis, requiring inpatient hospital admission and intravenous antibiotics. On admission, the patient had leukocytosis, elevated CRP, and ESR levels. CT facial bones showed pansinusitis and ruled out orbital cellulitis, acute intracranial abnormalities, and venous sinus thrombosis. After aggressive treatment with intravenous antibiotics and systemic steroids, the sinusitis resolved, as did her unilateral ptosis and facial swelling. Discussion: This is a unique presentation of ptosis that was treated successfully allowing for prompt and complete resolution. We want to highlight the establishment of a varying diagnosis and treatment courses which led to the final resolution of the acute ptosis. The patient was treated with meropenem and dexamethasone. The adjunctive use of corticosteroids, in this case, was beneficial.