Nayomi Perera1,2

Purpose: Orbital Cellulitis is a common disease with potentially severe complications that are infrequently encountered. Specific reports on subdural empyema and superior ophthalmic vein thrombosis as complications of orbital cellulitis are limited. This case is discussed in relation to the importance of appropriate imaging and prompt intervention and aims to highlight the importance of these significant complications.

Methods: We report a case of periorbital cellulitis that progressed to orbital cellulitis and was subsequently complicated by a subdural empyema and superior ophthalmic vein thrombosis.

Results: A previously well 10-year-old female presented to the Emergency Department with periorbital cellulitis and a history of trauma to her nose. The patient developed orbital cellulitis and fevers despite treatment with intravenous ceftriaxone and flucloxacillin and later metronidazole. CT imaging of the orbits demonstrated orbital fat stranding and enlarged right superior orbital vein but no orbital collection. Sinus washout performed by ENT cultured Citrobacter resistant to ceftriaxone.  Antibiotics were changed to gentamicin, which lead to improvement in periorbital swelling and erythema; interestingly there were no orbital signs. MRI brain was performed as a result of ongoing fevers and drowsiness and demonstrated a subdural empyema and right superior vein thrombosis. The patient required urgent surgical drainage, long-term antibiotics and long-term anti-coagulation.

Conclusion: In this context, we emphasize the clinical importance of the risk of subdural empyema development and superior ophthalmic vein thrombosis following orbital cellulitis. Awareness of these serious complications of this relatively common disease is particularly important for ophthalmologists to ensure appropriate imaging and prompt intervention.