A Periorbital Abscess with Combined Retinal Artery Occlusion and Retinal Vein Occlusion: A Case Report

Patient: Female, 17-year-old Final Diagnosis: Periorbital abscess • retinal artery and vein occlusion Symptoms: Blindness • nasal congestion • pain the eye • proptosis Medication: — Clinical Procedure: Drainage • endoscopic sinus surgery Specialty: Otolaryngology OBJECTIVE: Unusual clinical course BACKGROUND: Periorbital abscesses are uncommon complications of acute bacterial rhinosinusitis; with the evolution of diagnostic and therapeutic methods, it is rare that the patient progresses to irreversible blindness. Central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) rarely occur simultaneously and the factors that influence this occurrence are not well understood. CASE REPORT: This is a case report of an immunocompetent healthy adolescent girl, who developed irreversible blindness caused by a periorbital abscess secondary to acute bacterial rhinosinusitis due to CRAO and CRVO. Despite 6 days of clinical treatment, including intravenous antibiotics (vancomycin-associated piperacillin with tazobactam), she had a large periorbital abscess and could not open her left eye. Therefore, she was transferred to a tertiary hospital; 1 day after her admission, she underwent surgical treatment to drain the abscess through external and endoscopic access. In addition, she received broad-spectrum antibiotics (meropenem with vancomycin) for 3 weeks. She was no longer able to perceive light with the left eye, despite her clinical improvement. This case report discusses the factors that could have contributed to this poor outcome, despite clinical and surgical treatment. CONCLUSIONS: We conclude that there are several mechanisms that can lead to the loss of vision and when the indicated surgical intervention is delayed, it can increase the risk of visual sequelae.