Orbital Cellulitis Complicated by Subperiosteal Abscess in a Neonate with Ethmoiditis

Orbital cellulitis is extremely uncommon in neonates. We report a 28 day old baby who presented with sudden onset of fever, red and swollen right eye. The child had symptoms of nasal stuffiness 2 weeks prior to this presentation. Physical and laboratory findings were suggestive of orbital cellulitis. The baby was started on systemic broad spectrum antibiotics. Despite 48 hours of antibiotics, the fever continued and the orbital signs worsened. Computer tomography scan, revealed a subperiosteal abscess along the medial orbital wall associated with ethmoid sinusitis. Surgical drainage of the subperiosteal abscess was followed by resolution of the clinical condition. Majority of children aged 2 and younger respond well to conservative treatment and no surgical intervention is required, but in our case though the causative organism was sensitive to many antibiotics, there was no response to systemic antibiotics. Immediate surgical drainage was followed by rapid resolution of the condition.