Idiopathic intraconal abscess: A case report of rare condition with a diagnostic dilemma

Abstract Background Intraconal abscess is a rare complication of rhino-sinusitis that could cause permanent visual loss. Orbital, especially intraconal involvement without any inciting event is a very rare occurrence. Case Presentation: A 31-year-old male Ethiopian patient presented with 5 days history of painless protrusion of the right eye. Physical examination showed significantly decreased visual acuity is the right eye with very high intra-ocular pressure, significant proptosis, absent motility and high hyperopic shift. Laboratory investigations didn’t reveal any abnormalities, and orbital Computer Tomography and Magnetic Resonance Imaging were suggestive of intra-orbital abscess collection. Surgical drainage of the abscess with lacrimal gland incisional biopsy was done and sent for histopathology, culture and sensitivity. Histopathology results showed mild inflammatory infiltrate of the lacrimal gland, and culture and Sensitivity revealed Coagulase-negative staphylococcus species sensitive for ciprofloxacin. After 3 days of intravenous antibiotics, it was changed to oral ciprofloxacin 500 mg three times per day and sent home. He had mild lid swelling and motility started to return to normal on his early post-operative follow-up with improvement on hyperopic shift. Subsequently, on follow-up, the patient had a near-normal visual acuity with complete resolution of hyperopia, full motility and no proptosis. Conclusion Idiopathic intraconal abscess collection is an extremely rare presentation of patients with proptosis with significant diagnostic dilemma altering the course of treatment. Preoperative imaging followed by early surgical drainage and antibiotics is the definitive management that yields drastic improvement to the course of illness.