Diagnosis dilemma: A girl’s dental problems caused a life-threatening eye infection

Patient: A 6-year-old girl from the West Bank

Symptoms: The girl was brought to her primary dentist due to a headache, swelling around her right eye, a fever of 104 degrees Fahrenheit (40 degrees Celsius), and a toothache near her lumbar molars. She received acetaminophen to reduce temperature and oral antibiotics to combat the infection, but the swelling got worse. Following two episodes of vomiting, she was admitted to the pediatric ward of the hospital.

What happened next: The doctor gave patients an intravenous antibiotic containing vancomycin, which is often used in difficult-to-treat bacterial infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA). Her condition did not improve. Her eyes began to bulge out of the socket, and she developed double vision and light sensitivity. She could move these eyes a little, and the area around it was so swollen, shiny, flushed and warmly touching. Her left eye was also slightly swollen, but she still had the freedom to move it.

You might like it

A CT scan of the patient’s head showed that her right sinus cavity was very inflamed and therefore looked opaque on the scan. A closer look revealed swelling tissue around the eyes with the fat layer displaced. The doctor also wrote in the report of the incident that pus had accumulated in the orbit, known as a suborbital abscess.

Diagnosis: The ophthalmologist determined that swelling of the girl’s eyes was caused by a bacterial infection known as ophthalmitis. It can cause permanent vision loss by damaging blood vessels and nerves in the eye. Without treatment, the infection can spread to the bloodstream or the brain, leading to life-threatening complications. The doctor determined that the bacteria had moved from the patient’s original infection to the sinuses from the original infection of her teeth to the sinuses, then spread to her eyes.

Before 1985, orbital cellulitis was commonly associated with hamophilus influnza. But H. Since the influenza B vaccine, orbital cellulitis is usually caused by Staphylococcus aureus (also known as STAPH) and various species of streptococci.

Treatment: Orbital cellulitis can cause blindness and other dangerous complications, so doctors surgically removed the abscess to relieve pressure on the patient’s eyes. A few days later, the surgeon performed the surgery again and extracted two infected teeth. They created drainage openings in the patient’s sinuses and removed some polyps that had formed within her sinuses. She continued to receive intravenous antibiotics and her condition quickly improved. On a follow-up visit eight months later, her eyes looked normal and there was no loss of vision or mobility.

What makes the case unique is orbital cellulitis, which is far less common than periocular ophthalmositis. This is a superficial ocular infection that usually affects only the skin around the eye. In a study reviewing 10-year data from children hospitalized for ocular infections, orbital cellulitis accounts for only 17% of cases.

In children, approximately 90% of cases of orbital cellulitis are derived from sinus infections, and this condition is very rarely caused by dental problems. According to the authors of the report, so far, there have been only four such examples in the medical literature.