Presentation
Underlying diabetes. Presented with left eye pain and swelling. To rule out panophthalmitis and cavernous sinus thrombosis.
Patient Data
Left eye proptosis with multiple air locules within the globe. Increased enhancement of the left globe. Anterior sclera is thickened. Adjacent fat streakiness. However, the lens is normal. The adjacent extraocular muscles appear thickened. No rim-enhancing lesion involving the extra- or intraconal compartments otherwise.
Right globe and lens are of normal configuration. No intra-orbital fat stranding.
Bilateral extra-ocular muscles and optic nerves are symmetrical and preserved.
Both lacrimal glands are normal.
No superior ophthalmic vein dilatation.
No sellar or suprasellar mass.
Both cavernous sinuses are symmetrical.
Intra-operative tissue culture and pus culture show the absence of bacterial or fungal growth.
Case Discussion
On clinical examination, the anterior chamber was noted to be shallow. The relative afferent pupillary defect is (RAPD) positive. The patient also has proptosis, orbital swelling, frozen eye (severe ophthalmoplegia), and hypopyon.
The radiological diagnosis is left eye endophthalmitis. No CT evidence of cavernous sinus thrombosis.
Left eye evisceration was done later. Intra-operatively, the left eye globe was tight. There was diffuse chemosis, inflamed and thickened conjunctiva, and cornea haziness. Pus was scooped out. The final diagnosis is left eye panophthalmitis and orbital cellulitis. Post-operatively, intravenous vancomycin, ceftriaxone, and metronidazole continued for a total of 14 days.
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