Image-guided system endoscopic drainage of orbital abscess caused by methicillin-resistant Staphylococcus aureus in an infant.
BACKGROUND
The management of orbital abscesses in neonates and infants is very challenging. Surgical drainage of the abscess is aimed at removing the pus and preventing blindness. We describe a case of orbital abscess in an infant that was caused by methicillin-resistant Staphylococcus aureus and that was successfully drained with image-guided endoscopic surgery.


METHODS
A 39-day-old infant presented with progressive right maxillary swelling complicated by methicillin-resistant Staphylococcus aureus orbital abscess. Tooth bud abscess was the most likely primary cause and a combination of intravenous antibiotics was initially prescribed. The collection of intra-orbital pus was removed using image-guided system-aided endoscopic surgical drainage.


CONCLUSIONS
Prompt diagnosis and management are very crucial. Endoscopic drainage of these abscesses in children has been described. Image-guided drainage of the orbital abscess is a newer technique that has been reported in a teenager and in adult patients. This is the first reported case of endoscopic orbital drainage surgery in an infant. The procedure was performed successfully. This approach provides for better identification of the anatomical structures in a very young patient. Injuries to the medial rectus, globe and optic nerve can be avoided with this technique.


CONCLUSIONS
Aggressive management of orbital abscesses in infants is mandatory. Image-guided endoscopic orbital drainage offers precise visualization and a safer technique in a relatively smaller orbit.
Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Tan
T
Chai-Lee
Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Sanjeevan
S
Nadarajah
Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Baharudin
B
Abdullah
Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Irfan
I
Mohamad
Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Thevagi
T
Maruthamuthu
Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Chandran
C
Nadarajan
Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Talib
T
Norain
Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. Electronic address: shatriah@usm.my.
Ismail
I
Shatriah
Image-guided endoscopic drainage; Infant; Orbital abscess