Note: CT scans of
the eye can be seen below. We now believe
this bone lesion is what caused or prompted the eyelid swelling.
Notes:
This is what got us to the hospital
originally.
The doctors first though were
allergy or bug bite, but the swelling did not change with Benadryl.
In the 4/8 image you can see
the surgery and the drainage tube
The incision was placed exactly
on the natural fold of the eyelid, no scar should be visible
Explored about an inch back
Swelling did not reduce as quickly
as expected (via antibiotics), hence an MRI on the head was ordered
Ben is healing nicely.
Besides a little redness and a slight droop, you can hardly see the surgery.
CT Scans do show a bone lesion
on the outer left orbit.
Surgery findings:
No puss or anything that looks
like infection.
No signs of 'tumor'. Just
clear fluid.
Classified as Periorbital Cellulitis
(cellular swelling around the eye)
Later further defined as Preceptal
Cellulitis Orbititis (Forward cellular swelling in the orbit - the orbit
is the skull cavity holding the eye).
Testing for infection turned
out negative (but this could be attributed to the antibiotics given earlier)
Theories:
Theory 1: Swelling was
caused by an infection that was completely unrelated. That infection
responded to antibiotics. Probably not likely. The slowness
to react to antibiotics and the lack of any infection evidence (puss) seem
to back up the unlikely-hood of this.
Theory 2: The disease
weakened the immune system paving the way for an infection that responded
to antibiotics. Possible.
Theory 3: The orbital
bone degradation site caused a derma-cyst that burst and the body reacted
by swelling to reincorporate the foreign material. I think this one
is the most likely. Reduced swelling was not due to antibiotics.
Lack of any finding of puss or infection culture results of the tissue
support this.
Theory 4: The bone and
the eye blood system are closely tied in that region, the body & immune
system could be reacting to and fighting the eosinophilic granuloma (LCH
in the bone, specifically) in the orbit bone and we are seeing normal swelling
due to this battle. This is very likely.
CT & MRI of the Eye
Below are CT's of Ben's
eye from the emergency. I believe you can see the lesion in the bone.
It appears as the dark spot in the very bright bone of the orbit.
The arrow of the left image points directly to the dark spot. The
right image arrow points to the general area..
This MRI appears to show
the swelling in Ben's orbit.
