Spheno-Orbital Dermoid Masquerading as Recurrent Orbital Abscess

Area of Science:

• Pediatric Ophthalmology
• Neuroradiology
• Congenital Malformations

Background:

• Recurrent orbital abscesses in infants can be challenging to diagnose and manage.
• Initial treatment with systemic antibiotics and surgical drainage failed to resolve the abscess.
• Magnetic resonance imaging (MRI) was initially used to avoid radiation exposure in a young child.

Purpose of the Study:

• To investigate the cause of recurrent orbital abscesses in a 10-month-old infant.
• To highlight the diagnostic utility of computed tomography (CT) in identifying congenital dural sinus tracts.
• To emphasize the importance of considering CT in select pediatric cases despite radiation concerns.

Main Methods:

• Clinical presentation of eyelid edema and erythema.
• Initial MRI to evaluate orbital abscess.
• Recurrent abscess drainage and subsequent CT scan.
• Neurosurgical intervention for definitive tract removal.

Main Results:

• An orbital abscess was initially diagnosed and drained but recurred twice.
• CT scan identified a congenital dural sinus tract with dermoid in the sphenoid bone.
• Complete surgical removal of the tract, including cutaneous connection, was successful.

Conclusions:

• Congenital dural sinus tracts with dermoid can present as recurrent orbital abscesses in infants.
• CT scan is a critical diagnostic tool for identifying these tracts, even in young children.
• Careful consideration of CT is warranted in infants with complex or recurrent orbital infections.