Case Presentation:
A 49 year‐old female nurse presented to our hospital with a one‐week history of progressive swelling around her right eye. At the time of admission, she reported photophobia and a right‐sided headache but denied diplopia, sinus tenderness, or oral pain. She was diagnosed with periorbital cellulitis and was admitted for intravenous antibiotics.
The patient had had at least two prior episodes of periorbital cellulitis of the right eye within the previous two years and had also had milder episodes of right eye swelling which had resolved spontaneously. The patient had been evaluated by ENT on both prior episodes and had been treated as an outpatient with oral antibiotics. Both evaluations, which had included at least one CT scan of the sinuses, were negative for sinusitis. The patient's past medical history was significant for multiple medical problems, including rheumatoid arthritis, for which she was taking cyclosporine, diabetes mellitus, and thyroid cancer, for which she had undergone partial thyroid resection.
On exam, the patient was afebrile and other vital signs were stable. The patient had marked erythema and swelling around her right eye, particularly inferiorly with marked tenderness over the area of her maxillary sinus. Her right sclera was injected. Her vision and extraocular movements were intact and movements did not elicit pain. Exam of her nares and oropharynx was remarkable only for a few missing teeth. Remainder of her physical exam was unremarkable. A CT scan of the sinuses was ordered which revealed a periapical dental abscess with inflammation extending to the inferomedial aspect of the right orbit and the maxillary sinus. The patient was evaluated by an oral surgeon who took her to the operating room for extraction of tooth #6 and transoral incision and drainage of the right canine space infection under general anesthesia. The patient completed a course of antibiotics and has not had recurrence of periorbital cellulitis since discharge.
Discussion:
Periorbital cellulitis is a serious condition, which could lead to devastating complications if not adequately treated. Periorbital infection can lead to orbital cellulitis and abscess, which could result in loss of vision. Most cases of periorbital cellulitis require inpatient admission and treatment with intravenous antibiotics. Most cases of periorbital cellulitis are complications of rhinosinusitis. This case is very unusual in that the patient had a dental abscess which was asymptomatic but which was progressing and extending to involve the orbit. It is likely that her diabetes and relative immunosuppression due to the cyclosporine contributed to her condition and atypical presentation. Definitive treatment for this patient's condition required antibiotics and surgical debridement.
Conclusion:
This is an unusual case of a periapical dental abscess presenting as recurrent periorbital cellulitis.
Author Disclosure Block:
R. Chatterjee, None; M. Medford, None; M. Wilson, None.