A Case Presentation of an Atypical Eyelid Lesion in a Pediatric Patient

Title A Case Presentation of an Atypical Eyelid Lesion in a Pediatric Patient
Author, Co-Author Crystal Lewandowski
Program Number
Great Hall Foyer
Abstract Background: Methicillin-resistant Staphylococcus aureus (MRSA) ocular infections have been increasingly prevalent over the past decade occurring in young, healthy populations as well as in over 30% of S. aureus cultured ocular infections. The most common ocular presentation is orbital cellulitis, keratitis, and conjunctivitis and predictors for infection include male gender, age <1 year, and multiple site involvement. Vancomycin remains the gold standard treatment of invasive ocular infection, however for non-invasive cases, polytrim and linezolid have shown to be effective. Due to increasing antibiotic resistance and risk of life/sight threatening complications, it is important that optometrists are aware of latest recommendations and precautionary measures for MRSA management. 

Case report: An 8 year old female presented with an eyelid lesion and eye pain. Clinical exam revealed a large coalesced abscess at lower left lid margin involving hair follicles with purulent pus point and hemorrhage. Family denied recent insect bite, dental procedure, and trauma, but reported history of similar lesion on buttocks. Differentials considered included atypical appearance of chalazion, hordeolum, and capillary hemangioma as well as malignant rhabdomyosarcoma and carcinoma (squamous, basal, and sebaceous cell).  She was diagnosed with atypical hordeolum, treated with bactrim twice daily, and hand washing/personal hygiene importance was discussed. She was referred to ophthalmology for 1 day consult to determine need for culture and possible drainage, however it was decided to monitor patient since signs improved at all follow ups. Complete resolution was noted at 2 week visit. 

Conclusions: We report a rare case of pediatric MRSA infection of the eyelid; we discuss a review of the literature, treatment options, and recommendations for exam room disinfection. Accurate diagnosis and management is critical to reduce further antibiotic resistance and prevent the spread of infection within the community.
Affiliation of Co-Authors