Case discussion and theoretical basis for eyelid abscess drainage

1. Eyelid Abscess Drainage
Case Discussion and Theoretical Basis
17th January 2016
Dr. Anton Vurdaft
FICO, FCOphth(ECSA)

2. 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

3. CASE:
6 WO baby
with upper
eyelid abscess

4. CASE:
6 WO baby
with upper
eyelid abscess

5. 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

6. CASE:
6 WO baby
with upper
eyelid abscess

7. CASE:
Stab sub-brow
incision and
drainage
performed with
halothane
anesthesia
~ 4 ml of pus
evacuated

8. 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)

9. 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

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

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

12. Theoretical
Basis:
Incision should be
done along one of
these lines (to avoid
excessive scarring)

13. Theoretical
Basis:
Those lines are
aligned with the
fibers of orbicularis
muscle, check it on
the picture

14. What instruments are needed:
- Bard Parker Blade Holder
- Blade No. 15
- (or a simple shaving blade without blade
holder)
- Skin toothed forceps

15. Bard-Parker Blade Holder

16. Skin toothed forceps

17. Eyelid Abscess Drainage
Case Discussion and Theoretical Basis
17th January 2016
Dr. Anton Vurdaft
FICO, FCOphth(ECSA)