A Challenging case of paediatric orbital abscess

A 5 yr old girl who presented to us with redness and pain in the right eye of 4 days duration , fever with boils 3 days and lid swelling 1 day. Gives history of taking eye drops, injections and IV fluids at a local hospital. Right eye vision was perception of light with inaccurate projection of rays. Lid oedema, congestion, epithelial oedema, cells, flare and exudates and raised IOP. Left eye had vision 66 with normal clinical findings. B-scan showed mass in the infero-temporal quadrant with total retinal detachment. CT-scan showed nodular enhancing lesion without calcification.WBC count 15,400 cellscumm, ESR - 90mmhr.Later developed proptosis, iris seeding and multiple swelling over axillary area, shin and left lateral abdominal wall which were non-tender and non-mobile. CT-Scan confirmed it to be multiple abscesses. Frozen Section from eyelid swelling showed features of granulation tissue. She was on systemic and topical antibiotics, later on switched over to oral antibiotics . All her abscesses had resolved completely and she was discharged with a vision of perception of light. On 1 month follow up her right eye had become phthisical and she was fitted with a custom prosthesis