PMC9022152_01
Orbital ultrasound. (a) Showed the alteration of the morphology of the eyeball with thickening and alteration of the echogenicity of the covers. It also showed occupation of the vitreous chamber by heterogeneous hyperechogenic material (red arrow) and solution of continuity of the temporal ocular wall (white arrow) with outflow of the contents and adjacent collection (black arrow). (b) Doppler study showed destructuring of the posterior wall with vascularized intraocular membranes in relation to probable retinal and choroidal detachment (red arrow).
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F1
The patient was readmitted in our hospital and an ultrasound scan (Fig. 1(a), (b)) and an orbital MRI (Fig. 2(a)) were requested, showing intraocular and scleral destructuring with posterior scleral perforation (dehiscence of the sclera at the temporal level through which the purulent collection came out). The paranasal sinuses did not show occupation, so sinusitis was discarded as a cause of orbital cellulitis.
MRI. (a) On the first day of admission, the MRI showed an intraocular inflammatory process affecting mainly the posterior compartment with abundant detritus and retinal and choroidal destructuring. It also showed perforation of the temporal sclera with a parietal defect of 8 mm of maximum anteroposterior axis (red arrow) and discrete intraconal extension of the infectious process with slight edematization of retroocular fat and anterior fibers of the external rectus. Finally, intraorbital periocular purulent tissue was observed extending to the internal canthus. (b) A month and a half after admission, MRI showed collapse of the right eyeball with concentric thickening of its coverings without purulent signal. On the inferolateral border of the orbit, in an extraconal situation, between the internal rectum and lateral rectum, there were two collections of abscess semiology (black arrows)
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F2
Initially, there was an improvement in the periocular inflammation and disappearance of the subconjunctival purulent collection; however, the hypotonia of the eye increased, the cultures continued being positive for pseudomonas aeruginosa and there was no improvement in the MRI 2 months (Fig. 2(b)) after admission to our center, which showed phthisis bulbi of the RE.