Elevated Intraocular Pressure in Periorbital Sweet's Syndrome

Area of Science:

• Ophthalmology
• Dermatology
• Pathology

Background:

• Cellulitis around the eye can mimic serious conditions like necrotizing fasciitis or orbital compartment syndrome.
• Immunocompromised status increases susceptibility to severe infections and inflammatory conditions.
• Sweet's syndrome, or acute febrile neutrophilic dermatosis, typically presents with characteristic skin lesions and systemic symptoms.

Purpose of the Study:

• To describe a rare case of Sweet's syndrome presenting as severe periocular cellulitis.
• To emphasize the importance of urgent surgical and medical management in suspected orbital compartment syndrome.
• To correlate clinical findings with histopathological analysis for accurate diagnosis.

Main Methods:

• Clinical examination of a 66-year-old immunocompromised male with periocular cellulitis.
• Urgent surgical debridement, lateral canthotomy, and cantholysis.
• Ophthalmological assessment including intraocular pressure measurement.
• Histopathological analysis of eyelid skin biopsy.

Main Results:

• The patient presented with severe periocular erythema, edema, induration, and elevated intraocular pressure (35 mm Hg).
• Surgical intervention and antihypertensive eye drops normalized intraocular pressure.
• Histopathology revealed extensive neutrophilic infiltrate, confirming Sweet's syndrome.

Conclusions:

• Sweet's syndrome can present atypically with severe periocular inflammation mimicking orbital emergencies.
• Multidisciplinary approach involving ophthalmology, surgery, and dermatology is vital for diagnosis and management.
• Early recognition and treatment are essential to prevent vision loss and complications.