Purpose or Case Report: History
15 y/o female with congenital glaucoma presents to the emergency room with right eye pain, redness and swelling. She has baseline corneal opacifications and can see light and shadows but is otherwise visually impaired. The symptoms started 2 weeks prior foreign body sensation her right eye. Antibiotic drops were prescribed but symptoms continued to worsen. A week later another topical antibiotic was added but the eye began to swell, have increased pain, and developed discharge. Her opthomalogist referred her to the ER with concern of endophthalmitis (serious intraocular infection that affects the vitreous and/or aqueous humors of the eye).
Methods & Materials: Imaging performed
CT showed significant right orbital pre-and postseptal inflammatory process without abscess.
Ultrasound with Doppler demonstrated marked right globe wall thickening, hyperemia and intraconal and extraconal fat inflammatory changes, concerning for right globe abscess (endophthalmitis).
MRI revealed extensive inflammation of the right globe/orbit, globe rupture and endophthalmitis with early infectious spread to the right masticator space. Concern for panophthalmitis.
Results: Intervention
Due to the severe infectious process, enucleation (removal of the eye while keeping the muscles that control the eye in place) was completed. Cultures performed grew S. pneumonia which despite prompt treatment is associated with poor visual prognosis. A second surgery due to pus drainage around wound dressing was performed to clean out and repack the orbit. Once the infection was resolved, a prosthetic eye was placed during a third and final surgery.
Congenital glaucoma is a rare condition that may be inherited, in which the drainage system of the eyes have not developed correctly. Increased intraocular pressure that cannot be relieved in turn damages the optic nerve. It affects 1 in 10,000 newborns, bilaterally in 2/3^rd of cases, 2:1 males/females, and has no racial predilection.
Symptoms include photosensitivity, excessive tearing and unusually large, cloudy eyes. Diagnosis is usually made within the first year of life. Early diagnosis and intervention is key as 2-15% of those affected may become legally blind. Monitoring of these patients intraocular pressures (IOP) is indicated throughout life.
Conclusions: In this case study, imaging of the orbits with various modalities provided a complete depiction of a grave condition that allowed for prompt intervention and management of a difficult infection.