PMC6098209_01
A & B: External photograph showing right eye dystopia and proptosis, right upper and lower eyelid edema and erythema and conjunctival chemosis. C & D: Axial and coronal CT of the orbit with contrast showing dilatation of the right lacrimal sac, a large extraconal non-enhancing fluid collection seen adjacent to the right medial rectus muscle and causing mass effect on the globe.
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The clinical examination showed right upper and lower eyelid erythema and edema, which was tense on attempted retropulsion, and right eye proptosis with complete ophthalmoplegia (Fig. 1A & B). There was a large extraconal non-enhancing collection measuring 4.7 cm (anteroposterior) x 2.0 cm (transverse) x 2.1 cm (cranio-caudal) seen adjacent to the right medial rectus muscle and causing mass effect on the globe (Fig. 1C & D).
A: Significant purulent material was drained from the lacrimal sac and medial part of the orbit. B: Irrigation of the lacrimal drainage system showed the reflux coming through the wound drain which confirmed the nasolacrimal duct obstruction. C: Color fundus photo of the right eye showing temporal optic disc pallor. D: External photograph of the patient which was taken in the last follow up visit.
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Intraoperatively the abscess was drained from the lacrimal sac and medial part of the orbit (Fig. 2A) and a swab was taken from the purulent material for microbiology. Irrigation of the lacrimal drainage system showed the reflux coming through the drain which confirmed the nasolacrimal duct obstruction (Fig. 2B). He did not regain vision and developed right optic nerve atrophy (Fig. 2C & D).