To report a case of orbital cellulitis in an infant

CASE REPORT

An Indonesian baby at 29 day of life was brought by his parents to the emergency department of Universiti Malaya Medical Centre with a history of progressive left eye swelling for 1 week duration associated with intermittent low grade fever.
There was also history of another swelling at the left cubital fossa for 4 days.
History obtained from mother showed that baby was delivered at term via spontaneous vaginal delivery with no known medical illness.
The baby was active and feeding well till he was bitten by an insect over the left eye 1 week ago.Parents did not seek treatment till they noted pus discharge from the left eye since day 5 of illness.
Baby was brought to a General Practitioner and was given oral Augmentin,Paracetamol and Chloramphenicol ointment for the left eye swelling.
However,the condition was not improving and the left eye swelling was worsening.Parents revisited the General Practitioner
2 days later and was referred to Universiti Malaya Medical Centre for further management.
On Examination:
The baby was fretful,tachypnoeic with an oxygen saturation of 98% under room air.
Hydration status was fair.
Baby was unable to open the left eyelid due to the swelling.Skin overlying the swelling was erythematous and pus discharge was noted.
Immediate admission was done with referral to Ophthalmology by the Paediatric team.
Intravenous antibiotics, C-Penicillin 390 000 units BD and Cefotaxime 200 mg TDS was started.
Computed Tomography (CT) Brain/Orbit done showed a left periorbital and orbital abscess extending to the left maxillary and ethmoid sinuses with no evidence of intracranial extension.
Full Blood Count(FBC) showed a high white cell count (TWBC) of 16.9 with neutrophilic predominance of 67%.
Anterior segment examination showed moderate chemosis of conjunctiva with normal pupillary reaction.
Diagnosis of left Orbital Cellulitis was done.
Left external periorbital drainage was done on the same day (15/3/14) by the Oculoplasty team.
It was an uneventful procedure.
Intraoperatively,multiple punctate sinuses on the left upper lid and multiple loculations were noted with copious amounts of thick purulent discharge.
The pus was discharging into the superomedial fornix on pressure.Approximately,7ml of pus was removed.
Bone destruction over anterior wall of maxillary bone was noted.
2 weeks later,culture and sensitivity of the left eye swab showed Methicillin sensitive Staphylococcus Aureus and Pseudomonas Stutzeri which was sensitive to Gentamicin.
The baby was started on Intravenous Gentamicin 16mg OD and Intravenous Cloxacillin 200mg QID.
Currently,the baby is able to open the left eye spontaneously and the swelling over the left eye has resolved.

Detailed history and investigation should be performed in any child with swelling of the eye.Although controversy exists about the medical or surgical management of orbital abscesses in paediatric patients,prompt diagnosis and treatment in this baby has given excellent recovery results of this otherwise sight threatening condition.