PMC10286211_01
Clinical appearance of the patient before emergency surgery. (a) Fifty-year-old male with large edema and abscess of the left frontal and orbital area. (b) Close-up of the previous image that shows the lesions in different stages of Herpes Zoster in the affected area.
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Tension oedema extended to the lower temporal fossa with a fluctuating central area (Figure 1).
(a) MRI shows large edema's extension with a temporal abscess in the left side. (b) MRI shows left proptosis.
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A magnetic resonance imaging (MRI) scan showed left proptosis (an interzygomatic line to the sclera of 24 mm conditioned by obliteration of extra and intraconal fat with involvement of the lacrimal gland; a thickened left trigeminal nerve, and the optic nerve in the intraorbital and intracanalicular segment with neuritis) (Figure 2).
Transoperative view. (a) Cantholysis of the upper pillar of the canthal tendon. (b) Cantholysis of the lower pillar of the canthal tendon. (c) Drawing representing both cantholysis.
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Partial decompression was achieved, so an LC of the upper pillar was performed, quickly achieving significant tissue tension release (Figure 3).
Clinical appearance of the patient 2 weeks after procedure. (a) Temporary ptosis of the left upper eyelid. (b) Residual hyperpigmentation of the affected area can be seen.
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The patient evolved well and was discharged on the sixth postoperative day with symptom resolution and subsequent outpatient management (Figure 4).