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Periocular infection after strabismus surgery. The Periocular Infection Study Group
1Department of Ophthalmology, Pediatric Ophthalmology, Strabismus, and Genetics, Medical College of Wisconsin, Milwaukee, USA.
Abstract:
Fewer than 15 cases of cellulitis and subconjunctival abscess after extraocular muscle surgery have been reported in detail. In an effort to provide greater information about this serious complication, the members of the American Association for Pediatric Ophthalmology and Strabismus (AAPO&S) were surveyed and contributed cases were analyzed. Among the 25 cases of cellulitis, there was a predominance of preschool age patients and Staphylococcus aureus cultures. Many cases presented after a normal initial postoperative visit. The most common symptoms were marked swelling and pain. Possible predisposing factors included unsuspected sinusitis, eye rubbing, and poor hygiene. Two patients had documented bacteremia, but no patient developed endophthalmitis. All cases resolved on antibiotics, but only five patients were successfully treated with oral antibiotics alone. Periocular infections after extraocular muscle surgery can present after a normal initial postoperative visit. Symptoms of marked swelling and pain are cause for closer inspection. S. aureus is the most common organism and oral antibiotics alone can fail to halt the infection.
Insights
Periocular infections like cellulitis after extraocular muscle surgery are rare but serious. Staphylococcus aureus is a common cause, and prompt, often intravenous, antibiotic treatment is crucial for resolution.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Infectious Diseases
Background:
- Cellulitis and subconjunctival abscess are rare but serious complications following extraocular muscle surgery.
- Detailed reports on these post-operative infections are limited, necessitating further investigation.
Purpose of the Study:
- To survey members of the American Association for Pediatric Ophthalmology and Strabismus (AAPO&S) regarding cases of cellulitis and subconjunctival abscess after extraocular muscle surgery.
- To analyze contributed cases to provide greater information on this serious complication.
Main Methods:
- A survey was distributed to members of the AAPO&S.
- Contributed cases of cellulitis and subconjunctival abscess were analyzed.
Main Results:
- Twenty-five cases of cellulitis were analyzed, with a predominance of preschool-aged patients.
- Staphylococcus aureus was the most common organism cultured.
- Marked swelling and pain were the most common presenting symptoms, often appearing after a normal initial postoperative visit.
- Predisposing factors included sinusitis, eye rubbing, and poor hygiene.
- Two patients had bacteremia; none developed endophthalmitis.
- All cases resolved with antibiotics, but only five were successfully treated with oral antibiotics alone.
Conclusions:
- Periocular infections after extraocular muscle surgery can occur even after a normal initial postoperative visit.
- Marked swelling and pain warrant closer inspection for infection.
- Staphylococcus aureus is a frequent pathogen, and treatment with oral antibiotics alone may be insufficient.
