Unilateral Exophthalmos in Children
Pyocele: The infection in pyocele usually originates in one of the ethmoids although the antrum may be involved. These youngsters are quite ill, there is an increase in temperature, they have general malaise and complain of pain through the side of the head. Within a short time, signs of increasing congestion, edema of the lids, and some exophthalmos appear. The eye may not be pushed as far forward as it is laterally. There are no changes in the fundus early in the course of the disease but, as the inflammation proceeds, increasing congestion of the veins occurs and later the eye may show a low grade intra-ocular inflammation.
Examination of the nose usually reveals definite clinical evidence of sinusitis. Roentgen examination may show clouding of the sinuses but it rarely shows the orbital entrance or orbital lesion. Use of the suction apparatus is an aid in establishing the diagnosis.
In treating a patient with pyocele, he must first be put at complete rest with heat to the side of the face and eye. The nose must be kept open and constant drainage maintained by the use of suction or irrigation. The orbit should not be incised unless necessary as it is sometimes possible to avoid this procedure. Efforts should be directed toward causing the abscess to localize and, if necessary, the area or a dependent part of the orbit may be incised for drainage. Constant attention must be given to maintaining the integrity of the orbital contents in order to. . .