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      Isolated left upper eyelid ptosis with pansinusitis and contralateral otitis media in a 9-year-old boy

      case-report

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          Abstract

          Purpose

          Upper eyelid ptosis has different etiologies in children and adults. In children, the common causes include orbital cellulitis, congenital ptosis, Cranial Nerve (CN) III palsy, and Horner's syndrome. The purpose of this report is to discuss an unusual presentation of ptosis.

          Observations

          We describe a case of a 9-year-old boy with left-sided ptosis with no apparent clinical signs of orbital or preseptal infection. Magnetic resonance imaging (MRI) revealed pansinusitis and contralateral otitis media with direct extension into the superior aspect of the left orbit affecting the levator palpebrae superioris muscle.

          Conclusions and importance

          This finding on imaging disclosed the etiology of an otherwise unexplained case of upper lid ptosis.

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          Most cited references14

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          Orbital cellulitis in children.

          C. Woods, L B Givner, Danny Benjamin … (2006)
          To review the epidemiology and management of orbital cellulitis in children. The medical records of children < or = 18 years old and hospitalized from June 1, 1992, through May 31, 2002, at the Brenner Children's Hospital, with a discharge ICD-9 code indicating a diagnosis of orbital cellulitis and confirmed by computed tomography scan were reviewed. A literature search for additional studies for systematic review was also conducted. Forty-one children with orbital cellulitis were identified. The mean age was 7.5 years (range, 10 months to 16 years), and 30 (73%) were male (male:female ratio = 2.7). All cases of orbital cellulitis were associated with sinusitis; ethmoid sinusitis was present in 40 (98%) patients. Proptosis and/or ophthalmoplegia was documented in 30 (73%), and 34 (83%) had subperiosteal and/or orbital abscesses. Twenty-nine (71%) had surgical drainage and 12 (29%) received antibiotic therapy only. The mean duration of hospitalization was 5.8 days. The mean duration of antibiotic therapy was 21 days. Orbital cellulitis occurs throughout childhood and in similar frequency among younger and older children. It is twice as common among males as females. Selected cases of orbital cellulitis, including many with subperiosteal abscess, can be treated successfully without surgical drainage.
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            Guidelines for the management of periorbital cellulitis/abscess.

            Nicola L Howe, Andrea N. Jones (2004)
            Orbital and periorbital swelling secondary to acute sinusitis is relatively common. Distinguishing between preseptal and orbital involvement can be difficult based on clinical observations alone. A delay in diagnosis and appropriate treatment may result in serious complications including blindness. The literature is reviewed and simple guidelines suggested to manage such patients, including their initial assessment, investigations with particular reference to the indications and timing of CT scanning, antimicrobial therapy and the type of surgery. These guidelines have been approved across disciplines in our unit and trialled successfully for 2 years.
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              Blindness resulting from orbital complications of sinusitis.

              S Patt, S Manning (1991)
              Loss of vision remains a potential complication of orbital infection. Appropriate evaluation and management of the patient with signs and symptoms of orbital inflammation may prevent progression to blindness. Evaluation of patients with orbital inflammation from sinusitis includes a comprehensive clinical examination and radiographic studies. Clinical examination should test for changes in visual acuity, pupillary reactivity, and extraocular motion. Computerized tomography (CT) has facilitated the diagnosis of orbital infections and aids in diagnosis. However, CT can be misleading in patients with acute orbital infections and should not be relied on to determine the need for surgical intervention. We reviewed the records of all patients admitted to Parkland Memorial Hospital from 1978 to 1988 with orbital complications resulting from sinusitis. Four of 159 patients in this group had permanent blindness. The presence of an abscess, which was ultimately found at surgical exploration, was not diagnosed by CT in any of these four patients. Clinical examination remains the most important indicator for surgical intervention in patients with orbital complications of sinusitis. We present our findings and give guidelines for surgical intervention in patients with orbital infections resulting from sinusitis.
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                Author and article information

                Contributors
                Nathan D. Wilbanks
                Oliver R. Filutowski
                Michael D. Maldonado
                Zeynel A. Karcioglu
                Journal
                Journal ID (nlm-ta): Am J Ophthalmol Case Rep
                Journal ID (iso-abbrev): Am J Ophthalmol Case Rep
                Title: American Journal of Ophthalmology Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2451-9936
                Publication date PMC-release: 21 April 2018
                Publication date Collection: September 2018
                Publication date (Electronic): 21 April 2018
                Volume: 11
                Pages: 6-9
                Affiliations
                [a ]Department of Ophthalmology, University of Virginia, 1300 Jefferson Park Ave, Charlottesville, VA, 22908, USA
                [b ]University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA, 22908, USA
                [c ]Department of Radiology, Division of Neuroradiology, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA
                Author notes
                [∗ ]Corresponding author. 1339 E Market St, Charlottesville, VA, 22908, USA. ndw4y@ 123456hscmail.mcc.virginia.edu
                Article
                Publisher ID: S2451-9936(17)30395-X
                DOI: 10.1016/j.ajoc.2018.04.023
                PMC ID: 6058058
                PubMed ID: 30051000
                SO-VID: 45ecdae4-761d-4f57-9aaf-c52dbfb20a46
                Copyright © Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 27 December 2017
                Date revision received : 15 April 2018
                Date accepted : 18 April 2018
                Categories
                Subject: Case report

                Keywords: ptosis,pansinusitis,orbital cellulitis,otitis media
                Data availability:
                Keywords: ptosis, pansinusitis, orbital cellulitis, otitis media

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