Ewey Eyeballs

I was asked to see this lady in the isolation ward for the infection of her face.  She states that about 10 days ago, she experienced a brief pain in her right jaw.  The pain resolved but then her eyes started to swell.  I have never seen anything like this and I was happy that my friend, and current BMC surgeon Heidi Haun and returned from her travels. because truth be told . . . eye balls and surgery around eye balls sort of freak me out!   We are not sure why this has occurred but she mostly likely had an infection in one of her sinus that traveled to the skin around her eyes causing cellulitis, abscess, and eventual necrosis of the skin.  

 

Her upper and lower eye lid on the right eye was basically just two small islands of normal skin surrounded abscess and the yellow you see above and below the eye is skin that became necrotic and sluffed away.

The eye and surrounding structures are a complicated part of the body and so we went to our handy little library so look up some anatomy and check some textbooks.  There is a really useful book that is published for surgeons practicing in rural third world areas.  It was published a while ago, but is still a great resource that I often use.  It can sometimes be comical because it is written in English but in the way Africans speak English and then also, even though it is a medical textbook it will sometimes have funny opinions or running commentaries in the chapters.  At the beginning of the section about the eye it all caps large print was written, “DO NOT BE AFRAID OF SURGERY AROUND THE EYE SOCKET!!”  Well knowing that information Heidi and I felt right at home and were no longer worried tackling this unusual case!