Endogenous orbital cellulitis with optic neuropathy secondary to an intramuscular abscess in poorly controlled diabetes mellitus

Abstract

Orbital cellulitis is an inflammation of soft tissue posterior to the orbital septum. The predisposing factors are sinusitis, dacryocystitis, hordeolum, dental infections, and penetrating trauma. The hematogenous spread of infection from a distant source is unusual. A 50-year-old diabetic male with poor glycemic control presented with sudden visual loss and swelling of the left eye for 3 days. An intramuscular abscess in the upper arm was the primary source of infection. Clinical examination disclosed orbital cellulitis with optic neuropathy, confirmed on magnetic resonance imaging. Methicillin-resistant Staphylococcus aureus was isolated from the blood culture and pus culture. The patient showed a dramatic resolution with fasciotomy and abscess drainage, adequate glycemic control, parenteral clindamycin, and oral corticosteroids. An expeditious approach is vital to circumvent visual loss due to optic neuropathy. Endogenous orbital cellulitis can occur secondary to an intramuscular abscess. A distant source of infection should be vigilantly excluded in orbital cellulitis.

Keywords

• endogenous orbital cellulitis
• intramuscular abscess
• methicillin-resistant staphylococcus aureus
• uncontrolled diabetes