Retrobulbar Abscess in a Neonate

Abstract

Sir,Orbital tumours in newborns are rare. In most cases they are either solid embryogenic tumours such as dermoid cysts [3] or vascular malformations such as capillary haemangiomas [2]. Common clinical characteristics are exophthalmia, conjunctival injections, periorbital redness, and amblyopia. This clinical picture is also present in patients with retrobulbar abscesses. Since a congenital retrobulbar abscess seems to be a very rare condition a report of a further case may be of interest.A 10-day-old female was referred to our hospital because of redness and swelling of her right eye since birth. After an uneventful pregnancy she was born at 41 weeks of gestation. With the exception of the eye symptoms, her neonatal period was normal. Despite local administration of antibiotics assuming a conjunctival infection the eye symptoms worsened within the next days.At 10 days of age her right eye showed prominent protrusion of the bulb, periorbital swelling and hyperaemia, conjunctival injections due to a permanent lagophthalmia and a purulent fluid along the lid (Fig. 1). Internal and neurological examinations were normal, there was no history of fever. The laboratory parameters showed an erythrocyte sedimentation rate of 40 mm/h, a C-reactive protein of 1.3 mg/dl and a leukocytosis of 20,000 cells/l. Since the girls overall clinical picture resembled an infectious disease such as orbital phlegmone, we changed her medication to intravenous administration of ampicilline (100 mg/kg/d), oxacilline (100 mg/kg/d) and gentamycine (2 mg/kg/d). All vaginal cultures of the mother were sterile. Ophthalmologic examination did not reveal any abnormalities of the nasolacrimal ducts. MR imaging and CT scan of the orbits showed a large intraconal lesion (diameter 2 cm) located behind the globe and underneath the right optic nerve. The lesion presented as a homogenous structure, with sharp demarcation lines, poor contrast enhancement and a cyst within the central portion (Fig. 2 a).The lesion was biopsied using a transconjunctival approach. After a small incision along the inferior corner of the cornea, the conjunctiva was retracted and a solid encapsulated tumour was seen on the retrobulbar side of the muscle cone. Resection of the rostral capsule revealed a large amount of pus that was aspirated. Histological and microbiological examinations of the biopsy material established the final diagnosis of a retrobulbar abscess caused by Staphylococcus aureus and Streptococcus B. The patient was treated by local and intravenous application of antibiotics for a total of 18 days, followed by orally taking flucloxacilline for another seven days. Two months after treatment the girl showed only minimal exophthalmia of the Letter to the Editor

Neonatal orbital abscess

“…[5] Aspergilous [12] and streptococcus [8] has been reported as concomitant infections with Staphylococcus aureus . Nevertheless, orbital neonatal abscess secondary to methicillin-resistant Staphylococcus aureus (MRSA) has been reported after 2005, and it needs to be kept in mind while giving the proper antibiotics on presentation.…”

“…[58] It is worth noting that Klusmann[8] reported permanent lagophthalmia in a 10-day-old neonate, which had some residue after 2 months of treatment. In our case, the girl had eyelid retraction, which resolved spontaneously after successful treatment.…”