Acute Severe Eye Pain and Epistaxis in a 16-year-old Male Teenager ‐ What Clinical Clues May Aid a GP In Diagnosing Acute Sinusitis?

A 16-year-old teenager presented with acute severe eye pain and mild epistaxis. The family physician diagnosed an ophthalmologic emergency requiring evaluation. Acute sinusitis was not entertained. Subsequently, ENT evaluation and CT scan confirmed maxillary and anterior ethmoidal sinusitis. This lead to a search for criteria to improve diagnosis of acute sinusitis in the GP setting. Two or more of these symptoms ‐ mucopurulent rhinorrhoea, nasal obstruction/congestion, facial pain/pressure and decreased sense of smell increase its likelihood. Other important issues discussed include differential diagnosis of eye pain associated with epistaxis, potential orbital complications of sinusitis and causes of the quiet, non-red eye.

Orbital abscess secondary to ethmoidal sinusitis in neonates / 国际眼科杂志(Guoji Yanke Zazhi)

A subperiosteal abscess is a form of orbital cellulitis characterized by a collection of fluid and pus confined by the periosteal lining of the orbit. In neonates, orbital abscesses are extremely rare. We present a case of a 26-day-old baby girl with severe orbital cellulitis in the right eye. A computed tomography (CT) scan of the orbits and paranasal sinuses revealed right orbital cellulitis with medial subperiosteal and retro-orbital abscess. The growth of Staphylococcus aureus was found in eye discharges. The patient was started on intravenous ceftriaxone and intravenous metronidazole. Urgent drainage of the abscess was performed via functional endoscopic sinus surgery (FESS). She recovered well after intravenous antibiotics and surgical drainage. Surgical drainage via endoscopic technique is the preferred treatment to prevent further complications.