Ethmoid Sinusitis as a Possible Differential in Orbital Complications

Date

2020

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Marcincuk, Michelle
Jung, Esther

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Background: Reoccurring orbital complications due to sinusitis are rare and are evidenced in limited literature. This case study attempts to provide insight into the broad differential of periorbital swelling through a pediatric patient who presented twice with orbital complications due to ethmoid sinusitis. Case Presentation: An 8-month-old male presented to the emergency department with periorbital cellulitis and evidence of ethmoid sinusitis in the left eye. Following intravenous clindamycin, the patient improved and was discharged. A year and a half later, the patient presented with fever and swelling in the same eye; however, this time he was unresponsive to antibiotics. A computerized tomography (CT) scan identified left postseptal orbital cellulitis with a subperiosteal abscess. After an endoscopic left maxillary antrostomy, total ethmoidectomy, and decompression of the orbital abscess, the patient recovered well with no changes in vision and no reoccurrences of orbital complications to date. Conclusions: Although orbital abscesses due to ethmoid sinusitis are quite rare, it is important to consider ethmoid sinusitis as a primary cause. The treatment options include surgical intervention that must take place rapidly to avoid irreversible consequences. The risk of radiation exposure in this population is further complicated since orbital abscesses due to primary sinusitis can only be definitively diagnosed by CT imaging. It is important for healthcare providers to keep ethmoid sinusitis in mind when considering the differential of periorbital swelling to minimize the risk of permanent complications in their pediatric patients.

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