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A 10-month-old girl presented with eyelid edema and erythema that did not improve with systemic antibiotics. Due to a lack of improvement, MRI was performed to avoid ionizing radiation from CT. An orbital abscess was recognized and drained. However, the abscess recurred 2 times. CT scan was performed and a tract in the sphenoid bone helped to diagnose a congenital dural sinus tract with dermoid. Definitive surgery was performed with neurosurgery to remove the entire tract including cutaneous connection. CT scan proved critical to diagnosis and should be considered in infants in select cases despite the concern for ionizing radiation in this vulnerable age group.

Fabric monofilament polyethylene mesh is an implant primarily used in the repair of abdominal and chest walls. However, there have been isolated reports of using this implant in facial reconstruction. The authors describe a patient who underwent prior orbital floor fracture repair with polyethylene mesh and subsequently developed a recurrent orbital abscess 12 years later. Despite incorporation of the fabric monofilament polyethylene mesh within healed bone, an orbitocutaneous fistula developed after a secondary injury, causing hyperglobus and cicatricial lower eyelid retraction.

Pseudomonas aeruginosa conjunctivitis, although rare in healthy infants, may cause serious ocular and systemic complications. A 30-day-old, otherwise healthy male infant was referred with the diagnosis of right orbital abscess. The patient had been diagnosed as having Pseudomonas conjunctivitis 9 days previously at the referring center. Despite antibiotic treatment, his ocular findings had worsened and marked proptosis had developed. Other examination findings were ptosis, restriction of eye movements, periorbital erythema, and chemosis. Radiologic studies showed a large, homogenous mass with a thick capsule in the lateral retrobulbar orbit. The abscess was drained through a lateral orbitotomy. A culture of the abscess yielded P. aeruginosa. After surgery, the ocular findings improved rapidly without any complication. No other focus of infection or immune system abnormality was found. The patient did not experience any other significant disease during a follow up of 23 months.

The authors report a case of orbital cellulitis with abscess formation that developed after surgical management of canaliculitis. The patient developed pain, erythema, proptosis, and limited eye movements 3 days after canalicular debridement. She required urgent drainage of an orbital abscess and was treated with intravenous antibiotics for 2 weeks. Complications from surgical management of canaliculitis are unusual. Clinicians should be aware of the rare but serious risk of spread of the infection to the orbit.

A retrobulbar orbital abscess secondary to congenital dacryocystitis is extremely rare. External abscess drainage, probing, and syringing with broad spectrum intravenous antibiotics was performed in a 22-day-old neonate who was examined for congenital dacryocystitis complicated by retrobulbar orbital abscess formation.

A 74-year-old man sought treatment for painful swelling in the right upper eyelid. CT demonstrated a frontoethmoidal mucocele extending in the right orbit with abscess formation. Following functional endoscopic sinus surgery, the inflammatory symptoms in the right eye nearly resolved. However, a firm mass was still noted in the same location. Histopathologic examination proved it to be a benign fibrous histiocytoma. Benign fibrous histiocytoma may occur in association with an orbital abscess secondary to mucocele.

Purpose To describe the potential complication of intracranial abscess in the setting of orbital abscess. Methods We retrospectively reviewed case reports and the literature. Three patients were found to have pansinusitis progressing to subperiosteal abscess of the orbit and subsequent intracranial abscess. Results Three patients, ages 14, 26, and 57 years, with concurrent pansinusitis, subperiosteal abscess of the orbit, and intracranial abscess were treated with intravenous antibiotics and surgical drainage of the orbital abscess and sinuses. Two of the three patients required drainage of the intracranial abscess. Conclusions Although rare, intracranial abscess is a life-threatening complication of orbital abscess. It requires aggressive intervention by a multidisciplinary team.

Purpose: To assess the usefulness of a computer-assisted image-guided system (CAIGS) as an intraoperative anatomical guide in performing orbital surgery. Methods: Noncomparative interventional case series of 30 consecutive orbital procedures performed by one surgeon (J.G.C.) using the CAIGS (InstaTrak) for intraoperative anatomical guidance. Results: The series consisted of 8 cases of orbital decompression, 8 cases of orbital fracture, 11 cases of tumor excision, 2 cases of orbital reconstruction for severe enophthalmos, and 1 case of drainage of an orbital abscess. The CAIGS (InstaTrak) was useful in providing adjunctive intraoperative guidance in all 30 orbital cases. Conclusion: The CAIGS (InstaTrak) system is a useful adjunctive tool in providing intraoperative anatomic guidance in a consecutive series of varied orbital operations.