Title

INFECTIOUS RETINITIS AND CENTRAL RETINAL ARTERY OCCLUSION SECONDARY TO ORBITARY CELULLITIS

Introduction

Orbitary cellulitis (OC) is an infection of the orbital tissues, and the most common type of acute orbit in childhood and adolescence and the 3rd in adults. OC is in most cases, secondary to sinusitis.

Methods

A case report with medical record review

Results

16 yo female, was referred to the hospital, with history of productive cough, nasal discharge and fever for 10 days. Oral azithromycin was prescribed. However, she returned 4 days after with edema and periorbital erythema of the right eye (RE), proptosis, ophthalmoplegia and pain. Hospitalization was performed and intravenous antibiotic therapy was started. Visual acuity (VA) was light perception in her RE and 20/20 in the left eye. Biomicroscopy revealed ciliary injection and keratic precipitates. Fundus examination showed mild vitreitis, retinal necrosis in the macula, pallor of the retina and optic disc, diffuse vascular attenuation - compatible with infectious retinitis in the macula region concomitant to central retinal artery occlusion. A computered tomography showed: thickening of the extra and intraconal fat; and an extra axial collection. A septoplasty and sinusotomy were done, with drainage of a large amount of purulent secretion. One week after the surgical procedure the patient had a worsening of the VA of the RE to no light perception, improvement in proptosis and normal eye movement without pain. OCT showed an increase in the thickness of the sensorineural retina with intra and pre-retinal collections. Antibiotic therapy was maintained for 8 weeks. The RE maintained VA and fundoscopy showed regression of macular lesions with an extensive area of atrophy of the retina, corresponding to the area of infection.

Discussion

The four common factors involved in visual loss mechanisms in OC are: increased orbital pressure, extent of infection/inflammation, and vascular inflammation leading to vasculitis and thrombosis; Despite early treatment with surgery and antibiotic therapy in this case, the sequel couldn’t be avoided.

Keywords

Infectious retinitis; central retinal artery occlusion; orbital celullitis

Area

CLINICAL CASE

Authors

Alice Silva Case, Rafael Cicconi Arantes, Juliana Abreu Rio, Lana Martins Menezes, César Luz Leitão Guerra, Ricardo Luz Leitão Guerra