Painful Lid Swelling
Case Study:
Dr Charles Su
Presentation
60 year old diabetic man presents with a 3 day history of a progressively swollen and painful left eye region.
What signs in the clinical photo suggest that there is inflammation occurring in this region ?
Swelling and redness.
What signs in the clinical photo suggest unequivocally that the process involves the orbit? In other words, that the process is deep in its extent, and well beyond the skin of theregion and the eyelids?
Proptosis and inferior displacement of the globe.
What other signs indicate involvement of the orbit in any given situation ?
Although displacement of the globe is a cardinal sign of orbital involvement, disturbance in oculomotility, and nerve function loss, such as a paresis of the third, fourth, or sixth cranial nerves, or loss of sensory function of the lids or part of them ( supplied by the Trigeminal nerves first division), are also signs of orbital disturbance. An optic neuropathy, which would lead to signs such as reduced acuity, colour vision, and visual field, and an afferent pupil defect (detected by the swinging light test), would likewise indicate deep involvement. These signs do not necessarily have to be present in orbital pathology, but must be taken very seriously if they are.
There is an abnormality in the CT scan in the superomedial orbit. In an inflamed orbit such as this what could this mean? How does it need to be managed ?
There is an abscess in the orbit next to the bony wall; a sub periosteal abscess. Orbital cellulitis is frequently associated with such a collection. Surgical drainage is required, as in all collections of pus.
In diabetic patients, particularly if they are unstable, there is a rare form of orbital cellulitis which can be rapidly fatal. Do you know what it is ?
Orbital mucormycosis, caused by a fungal infection.