Case Presentation
The patient is a 76-year-old white male who tested positive for COVID-19
but was sent from a nursing facility for left eye drainage and
”psychiatric evaluation.” Upon presentation, the patient was not fully
oriented and could not provide a history of the eye drainage. His past
medical history is significant for hypertension, Type 2 diabetes
mellitus requiring insulin, diabetic ketoacidosis, testicular cancer,
and transient ischemic attack. CT scan upon presentation showed
sinusitis with left orbital and periorbital abscess formation,
cellulitis, and extensive osteomyelitis (Figures 1-3). The margin of the
orbital abscess was within the inferior margin of the globe, where there
appeared to be an open defect within the globe itself. The patient also
had a chest x-ray showing some patchy infiltrates, particularly in the
right lung, consistent with a COVID-19 infection.
The patient was admitted and subsequently underwent endoscopic left
middle turbinate reduction, endoscopic left maxillary antrostomy with
tissue removal, and endoscopic anterior ethmoidectomy with the
Otolaryngology service the following day. The patient also underwent
left orbiotomy with drainage of the left orbital abscess with the
Opthalmology service that same day. During surgery, his nasal cavity was
oddly avascular (Figure 4). The turbinate was edematous but pale. The
mucosa did not bleed when manipulated. When the bone of the middle
turbinate and medial wall of the maxilla were removed with Tru cut
forceps, they did not bleed. The fat of the orbit was pale. Cultures
were taken during surgery and returned positive for MRSA, Streptococcus
constellatus, and Peptoniphilus indolicus. He completed several days of
intravenous antibiotics during the hospitalization but continued to have
drainage from his left eye (Figures 5-6). Otolaryngology evaluated him
daily and had no plans to do further surgery. He was deemed
hemodynamically and neurologically stable and was transferred back to
his nursing facility for completion of intravenous antibiotics.