Eyelid abscess drainage

Eyelid Abscess Drainage

Case Discussion and Theoretical Basis17th January 2016

Dr. Anton VurdaftFICO, FCOphth(ECSA)

CASE• Female 6 weeks old with history of sudden onset of swollen eyelid 4

days ago.• No history of trauma or insects bites• No fever• Lid tender and red, tarsal conjunctiva chemosis• History of warm compresses for the same

CASE:

6 WO babywith upper eyelid abscess

CASE:

6 WO babywith upper eyelid abscess

PITFALLS:• Eyelid abscess could be related to sinusitis (paranasal sinuses

radiography mandated)• Could lead to orbital abscess and cavernous sinus abscess• IV antibiotics (ceftriaxone 50 mg/kg IV in single dose or divided in two

doses daily for 7-14 days)• After 7 days of IV therapy oral treatment may be initiated instead• Incision and drainage is a must if there’s a fluctuation

CASE:

6 WO babywith upper eyelid abscess

CASE:

Stab sub-brow incision and drainage performed with halothane anesthesia

~ 4 ml of pus evacuated

PITFALLS:• Evacuate all the pus, but avoid damaging the deeper tissues• Leave the sterile drainage (gloves) for 2 days• Incision is mandatory if the subcutaneous fluctuation is

obvious, i.e. pus collection is presumed• Incision should only penetrate the skin, subcutaneous fat and

subcutaneous muscle (orbicularis) if required• Septum and levator aponeurosis should remain intact• Continue systemic therapy (antibiotics, painkillers)

Anatomy• Abscess is a collection of pus in the interstitial space (above or under

the orbicularis muscle)• In this case pus was collected under the orbicularis muscle, but did

not penetrate the orbital septum

Theoretical Basis:Mind the localization of skin, orbicularis muscle, levator aponeurosis and orbital septum

Theoretical Basis:Mind the localization of skin, orbicularis muscle, levator aponeurosis and orbital septum

Theoretical Basis:

Incision should be done along one of these lines (to avoid excessive scarring)

Theoretical Basis:

Those lines are aligned with the fibers of orbicularis muscle, check it on the picture

What instruments are needed:- Bard Parker Blade Holder- Blade No. 15 - (or a simple shaving blade without

blade holder)- Skin toothed forceps

Bard-Parker Blade Holder

Skin toothed forceps

Eyelid Abscess Drainage

Case Discussion and Theoretical Basis17th January 2016

Dr. Anton VurdaftFICO, FCOphth(ECSA)