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A 70-year-old man was admitted under the medical and ophthalmology team with a 1-day history of sudden-onset, right-sided, periorbital swelling. He denied any broken skin or local trauma. He had no relevant medical history and was not immunocompromised. On initial examination, the periorbital area was swollen, erythematous and indurated, with desquamation of the lower lid. There were no orbital signs. The patient was mildly tachycardic but afebrile. An urgent CT head demonstrated orbital cellulitis predominantly involving the preseptal space with some intraorbital extension. A degree of maxillary and ethmoid sinus opacification was also noted. A diagnosis of orbital cellulitis secondary to acute sinusitis was made, and the patient was started on intravenous Tazocin, as per local microbiology guidance.
There was initial improvement in clinical symptoms and laboratory markers; however, 48 hours after starting antibiotics, the infraorbital area deteriorated and appeared necrotic and increasingly swollen (figure 1). ENT (ear, nose and throat) input was requested to …
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