Presentation
An 88-year-old woman was referred to the Wills Emergency Room for evaluation of a painful, red right eye with periorbital swelling that was progressive over five days without change in vision. She had been seen by her ophthalmologist who prescribed Tobradex ointment, with no improvement. The day of her evaluation, she had presented to a general emergency department, where a CT scan of the orbits demonstrated a possible abscess.
Medical History
The patient had a history of hypertension, congestive heart failure, atrial fibrillation and chronic obstructive pulmonary disease. She was anticoagulated on warfarin, and had a permanent pacemaker implanted. She had significant joint restriction in her extremities due to osteoarthritis. Her prior ocular history was significant for retinal detachment and surgical repair in the early 1990s, with resultant low vision, as well as glaucoma, macular degeneration and prior cataract surgery.
Examination
The patient's best corrected visual acuity was count fingers only in the right eye, and 20/30 in the left eye. Intraocular pressure was 25 mmHg in each eye. The pupils were round and reactive to light without an afferent pupillary defect. Slit-lamp biomicroscopy of the right eye was remarkable for 2+ chemosis and 3 to 4+ injection of the conjunctiva. The cornea was clear and the anterior chamber was deep and quiet. A posterior chamber intraocular lens was in good position. The left eye was notable for a posterior chamber intraocular lens.
