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Orbital abscess due to accidental rupture of frontal mucocele during peribulbar anesthesia

Poster Details

First Author: L.León Ibáñez SPAIN

Co Author(s):    M. Pena   R. Banon Navarro   A. Ordonez Arana   A. Montoliu Anton   E. Sorli Clemente   F. Ramos Marti     

Abstract Details

Purpose:

The aim of this report is to describe the diagnosis and management of a rupture of frontal mucocele as an unusual complication of the peribulbar anesthesia technique.

Setting:

General University Hospital of Castellon

Methods:

Routine extraconal anesthesia with lidocaine 1% + ropivacaine 0.375% + hialuronidase 15 ui/ml was performed using an inferior-lateral approach with 5 millilitres and then, the superior-medial approach with 3 millilitres. Except for the patient´s complaint of profound pain, uneventful cataract surgery was performed. The day after, the patient presented proptosis, chemosis and limited eye movements. Orbital CT scan showed chronic frontoethmoidal mucocele with superior orbital wall erosion and presence of mucopurulent discharge inside the orbital space, displacing the eyeball down. Urgent abscess drainage was performed with nasal endoscopic technique through the lamina papyracea and transpalpebral way through superior palpebral crease.

Results:

The patient was admitted to the hospital for a 4-day course of IV Ceftazidime + Metronidazole. One month later, all signs of orbital swelling had regressed, visual acuity was 20/20 and an orbital CT scan was performed, showing partial occupation of the frontal and ethmoidal sinuses without involvement of the orbital space.

Conclusions:

Orbital abscess secondary to accidental rupture of an unknown frontal mucocele is a very rare complication of the peribulbar anesthesia. Urgent abscess drainage and IV antibiotherapy is needed if there is any risk of visual impairment. If it is possible, topical anesthesia in the cataract surgery should be considered as a first option in order to minimize future complications.

Financial Disclosure:

NONE

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