Periorbital infections secondary to methicillin-resistant Staphylococcus aureus

June 1, 2007

With periorbital soft-tissue infections on the increase due to methicillin-resistant Staphylococcus aureus (MRSA), physicians must be suspicious of MRSA and aware of local resistance profiles in order to treat these infections effectively.

Key Points

Dr. Levinson, a fellow in the cornea service at Wills Eye at Jefferson, Philadelphia, presented findings from a small retrospective study at the American Academy of Ophthalmology annual meeting. The senior author of the study was Sajeev S. Kathuria, MD, FACS, director of oculoplastics service, University of Maryland, Baltimore.

Lid/brow was the most common site of infection in all patients. Among those with an MRSA infection, eight had lid or brow abscesses, one had panophthalmitis as well as a lid abscess, one had a lacrimal gland abscess, and one had an infected orbital implant.

One of the patients with MSSA had a lid or brow abscess and one had a subperiosteal abscess. Both patients with an unknown cause of infection had lid or brow abscesses.

Irrigation and debridement (I/D) was the most commonly used management approach for patients with MRSA and was performed on eight individuals, Dr. Levinson reported. One patient underwent enucleation, one underwent explantation of an orbital implant, and one received medical treatment only. One MSSA patient underwent I/D and one had medical therapy; both patients with unknown cultures had I/D.

MRSA was classified as health care-associated in the study if the culture was identified after 48 hours of admission; the patient had been hospitalized, had surgery or dialysis, or had been in long-term care within 1 year of the culture; or the patient had a permanent indwelling catheter or a known prior positive MRSA culture.