Detection of orbital implant infection with technetium 99m-labeled leukocytes

Orbital implant infection is a rare cause of anophthalmic socket pain. Because of the potential danger of infection spreading to nearby structures, it is of paramount importance to diagnose the condition as soon as possible. Scintigraphy is a method for diagnosis of graft infections by radioisotopic imaging of inflammatory sites. We report on a patient with socket pain 3 months after implantation of an acrylic implant. The socket appearance was normal and there were no signs of infection other than culture-positive socket exudation. Three consecutive computed tomography scans revealed no abnormalities. 99mTc leukocyte scintigraphy revealed white blood cell accumulation at the implantation site. The implant was removed and cultured. This produced Staphylococcus epidermidis and R. equii. A parenteral antibiotic treatment was instituted with subsequent improvement of symptoms. Four months later, after negative scintigraphy, a hydroxyapatite implant was inserted, demonstrating full vascularization on a bone scan after 2 months. Two months later, the patient developed the previous symptoms, with all of the former findings, including positive scintigraphy. The implant was removed, revealing a microabscess on the anterior aspect, producing S. epidermidis on culture. We conclude that scintigraphy using 99mTc-labeled leukocytes is a useful technique in diagnosing low-grade orbital infection.