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Distinguishing between a cerebrospinal fluid (CSF) collection of the upper eyelid and an abscess can be challenging, as the following case demonstrates. Each may be preceded by surgical intervention and both could present with pyrexia. Good clinical skills will assist in differentiation, but laboratory tests are required to provide the final diagnoses.
A 24-year-old man with a Glasgow Coma Scale score of 3 was admitted to an intensive care unit following a motor vehicle crash with right orbital fractures as seen on computed tomography. He was ventilated on admission and extubated on day 12, when he developed right proptosis and entropion. Although forced duction testing was not performed, he had no extraocular movements of his right eye as seen with the vestibulo-ocular reflex. No disc swelling was present.
Heydenrych LG, Aldous CM, Giles R, du Plessis GA, Meyer B. Cerebrospinal Fluid in the Upper EyelidAn “Abscess” of a Different Kind. JAMA Ophthalmol. 2014;132(12):1485–1486. doi:10.1001/jamaophthalmol.2014.2866
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