Bilateral blindness from orbital cellulitis caused by community-acquired methicillin-resistant Staphylococcus aureus.
OBJECTIVE
To describe bilateral blindness resulting from infection with community-acquired methicillin-resistant Staphylococcus aureus (MRSA).


METHODS
Observational case report.


METHODS
A 44-year-old man developed proptosis, ptosis, ophthalmoplegia, and no light perception vision after attempting to lance a nasal pustule. A nasal culture grew MRSA. Imaging showed bilateral orbital cellulitis, pansinusitis, and cavernous sinus thrombosis. The right fundus showed severe ischemia, but the left fundus was essentially normal.


RESULTS
Despite initiation of appropriate antibiotics early in the course of infection, the patient lost sight in both eyes. Surgical drainage of the paranasal sinuses and use of intravenous corticosteroids and heparin led to the resolution of orbital cellulitis.


CONCLUSIONS
MRSA orbital cellulitis can progress to irreversible blindness despite antibiotic treatment. A new, community-acquired clone of this organism has exhibited increased potential for tissue invasion.
Rutar
Tina
T
Beckman Vision Center, University of California San Francisco, San Francisco, California 94143-0730, USA.
Zwick
Orin M
OM
Cockerham
Kimberly P
KP
Horton
Jonathan C
JC
D000328:Adult; D001766:Blindness / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D020226:Cavernous Sinus Thrombosis / Q000175:diagnosis / Q000382:microbiology; D002481:Cellulitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004322:Drainage / Q000379:methods; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005451:Fluorescein Angiography; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D016106:Methicillin Resistance; D008775:Methylprednisolone / Q000627:therapeutic use; D009916:Orbital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012852:Sinusitis / Q000175:diagnosis / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification
D006493:Heparin; D008712:Methicillin; D008775:Methylprednisolone