Fulminant orbital cellulitis with compartment syndrome and vision loss due to streptococcus pyogenes: A case report

Authors : Pratima Chavhan, Nirupama Kasturi, Gayathri Panicker

DOI : 10.18231/j.ijceo.2020.100

Volume : 6

Issue : 3

Year : 2020

Page No : 467-469

Purpose: To describe an unusual case of fulminant orbital cellulitis with complete vision loss despite timely
medical and surgical management.
Observation: Orbital cellulitis is an infective condition of the ocular adnexal structures (fat, periorbita,
and muscles) behind the orbital septum. A 22-year-old female presented with rapidly progressing orbital
cellulitis and was started on empirical intravenous antibiotics. Orbital imaging showing marked proptosis
with optic nerve stretching and an extraconal abscess in the medial aspect of left orbit. Emergency lateral
canthotomy and orbital decompression was done. Streptococcus pyogenes was isolated on culture and
antibiotics changed according to the sensitivity pattern. Lid edema, proptosis, and extraocular movements
improved but vision deteriorated to absent light perception. Fundus showed disc pallor on follow up. A case
of fulminant orbital cellulitis with compartment syndrome and ischemic necrosis of optic nerve is reported,
which led to permanent vision loss despite timely antibiotics and surgical management.
Conclusion: Despite prompt surgical intervention and administration of intravenous antibiotics, the
patient may develop compartment syndrome, ischemic necrosis or infiltration of the optic nerve leading
to complete vision loss.Orbital cellulitis is an infective condition of the ocular adnexal structures (fat,
periorbita, and muscles) behind the orbital septum. This condition is more common in children and young
adults and usually results from a paranasal sinus or any facial infection. 1 The majority of the organisms
isolated are Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae B and Moraxella
catarrhalis. Beta-hemolytic streptococci are rarely implicated. Bacterial cellulitis usually responds well to
antibiotics but rarely may result in vision or life-threatening complications.

Keywords: Abscess, Compartment syndrome, Orbital cellulitis, Orbit, Pain, Streptococcus pyogenes.

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