A 6-week-old female baby presented with a swollen upper eyelid for 4 days without trauma or fever. Examination found a tender, red eyelid with chemosis. An abscess was located under the orbicularis muscle of the eyelid. Incision and drainage was performed under anesthesia, evacuating 4 ml of pus. Systemic antibiotics were continued to treat the abscess and prevent complications like orbital or cavernous sinus abscesses. The theoretical basis emphasizes properly localizing the skin, orbicularis muscle, levator aponeurosis, and orbital septum when performing incision and drainage of an eyelid abscess.

1. Eyelid Abscess Drainage
Case Discussion and Theoretical Basis
17th January 2016
Dr. Anton Vurdaft
FICO, FCOphth(ECSA)

2. CASE
• Female 6 weeks old with history of sudden onset of swollen eyelid 4
days ago.
• No history of trauma or insects bites
• No fever
• Lid tender and red, tarsal conjunctiva chemosis
• History of warm compresses for the same

3. CASE:
6 WO baby
with upper
eyelid abscess

4. CASE:
6 WO baby
with upper
eyelid abscess

5. PITFALLS:
• Eyelid abscess could be related to sinusitis (paranasal sinuses
radiography mandated)
• Could lead to orbital abscess and cavernous sinus abscess
• IV antibiotics (ceftriaxone 50 mg/kg IV in single dose or divided in two
doses daily for 7-14 days)
• After 7 days of IV therapy oral treatment may be initiated instead
• Incision and drainage is a must if there’s a fluctuation

6. CASE:
6 WO baby
with upper
eyelid abscess

7. CASE:
Stab sub-brow
incision and
drainage
performed with
halothane
anesthesia
~ 4 ml of pus
evacuated

8. PITFALLS:
• Evacuate all the pus, but avoid damaging the deeper tissues
• Leave the sterile drainage (gloves) for 2 days
• Incision is mandatory if the subcutaneous fluctuation is
obvious, i.e. pus collection is presumed
• Incision should only penetrate the skin, subcutaneous fat
and subcutaneous muscle (orbicularis) if required
• Septum and levator aponeurosis should remain intact
• Continue systemic therapy (antibiotics, painkillers)

9. Anatomy
• Abscess is a collection of pus in the interstitial space (above or under
the orbicularis muscle)
• In this case pus was collected under the orbicularis muscle, but did
not penetrate the orbital septum

10. Theoretical
Basis:
Mind the
localization of
skin, orbicularis
muscle, levator
aponeurosis
and orbital
septum

11. Theoretical Basis:
Mind the localization
of skin, orbicularis
muscle, levator
aponeurosis and
orbital septum

12. Theoretical
Basis:
Incision should be
done along one of
these lines (to avoid
excessive scarring)

13. Theoretical
Basis:
Those lines are
aligned with the
fibers of orbicularis
muscle, check it on
the picture

14. What instruments are needed:
- Bard Parker Blade Holder
- Blade No. 15
- (or a simple shaving blade without blade
holder)
- Skin toothed forceps

15. Bard-Parker Blade Holder

16. Skin toothed forceps

17. Eyelid Abscess Drainage
Case Discussion and Theoretical Basis
17th January 2016
Dr. Anton Vurdaft
FICO, FCOphth(ECSA)