J Korean Ophthalmol Soc.  2014 Apr;55(4):616-622.

A Case of an Isolated Abscess in an Extraocular Muscle

• Park JH
• Jun RM

Abstract

PURPOSE
To report the case of an isolated abscess in an extraocular muscle.
CASE SUMMARY
We report a case of an isolated abscess in an extraocular muscle in a patient who was treated with systemic chemotherapy for precursor B lymphoblastic leukemia. A 54-year-old female who had undergone systemic chemotherapy for precursor B lymphoblastic leukemia presented with right ocular pain and limited eye movements. On ophthalmic examination, she had elevated intraocular pressure (IOP) and limited upward and downward gaze. MRI (magnetic resonance imaging) examination revealed an isolated abscess in right inferior rectus muscle. Although the patient was treated with empirical intravenous antibiotics and IOP-lowering agents, the size of the abscess increased, as confirmed by MRI findings. Therefore, we performed a pus drainage procedure by the transconjunctival approach. We were not able to find any residual abscess lesions on CT scans 3 months postoperatively. The patient's ocular pain disappeared and the limited eye movements improved significantly 6 months postoperatively.
CONCLUSIONS
There have been no case reports of an isolated abscess in an extraocular muscle in Korea. For immunocompromised patients unresponsive to systemic empirical antibiotic treatment, an early pus drainage procedure by the transconjunctival approach may be a useful and effective therapeutic method in the management of an idiopathic isolated abscess in an extraocular muscle.

Keyword

Aspiration; Cystic lesion; Extraocular muscle; Orbital abscess; Pus drainage

MeSH Terms

Abscess*
Anti-Bacterial Agents
Drainage
Drug Therapy
Eye Movements
Female
Humans
Immunocompromised Host
Intraocular Pressure
Korea
Magnetic Resonance Imaging
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Suppuration
Tomography, X-Ray Computed
Anti-Bacterial Agents

Figure

• 

  Figure 1. Initial examination. (A) Mild limitation on up-gaze and obvious limitation on down-gaze in the right eye was confirmed. (B) Brain MRI scan showed a large (6.5 mm × 5.0 mm) cystic lesion (white arrow) with surrounding rim enhancement and irregular wall structure in the right inferior rectus muscle, suggesting an intramuscular abscess.

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  Figure 2. Two weeks after medical treatment of intravenous antibiotics. (A) In the right eye, limitation on down-gaze was much decreased, but limitation on up-gaze was still observed. (B) Brain MRI scans showed a larger (9.0 mm × 8.0 mm) cystic lesion (white arrow) in the right inferior rectus muscle, suggesting that the size of abscess pocket did not decrease but rather became larger despite systemic empirical antibiotics treatment.

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  Figure 3. One week postoperatively. (A) Limitation on up and down-gaze in the right eye was continuously observed post-operatively, but the degree of limitation was reduced compared to immediate postoperative conditions. (B) Brain MRI scans showed a remnant cystic lesion (white arrow) with residual inflammation confirming the removal of a large abscess pocket.

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  Figure 4. Three months postoperatively. Orbit CT scans indicated that an intramuscular abscess in the right eye was completely removed by drainage and we could not find any residual lesions.

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  Figure 5. Six months postoperatively. Only mild limitation on down-gaze in the right eye was observed.

Reference

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