A 74-year-old woman presented with bilateral epiphora, greater in the left eye (LE), with no episodes of acute dacryocystosis woman.
As a personal history of interest, the patient presents hypertension in treatment and surgical drainage of the sinuses, and sinusitis in his youth.
The visual acuity (VA) was 0.3 in both eyes.
This vision was justified by the existence of cataracts and also had bilateral lacrimal obstruction.
A left dacryocystography was performed and later a straight Wacrees prosthesis was implanted without complications.
After 24 hours, the patient complained of pelvic inflammation and pain in the left orbital region.
After 48 hours she complained of sudden loss of visual acuity of the left eye with poor general condition and fever (37.6o).
The patient came to the emergency room 72 hours later, presenting a 50 cm vision of movement of the hands, marked exophthalmos with periocular inflammatory signs and symptoms compatible with ocular mycoses.
Ophthalmoscopy showed a normal papilla with a negative spontaneous venous pulse.
The emergency blood count showed leukocytosis with left shift.
The cranial CAT scan performed was compatible with orbital lithiasis.
The patient also had a left optic neuritis due to intraorbital compression.
Systemic treatment was established with methylprednisolone (250 mgr/iv/6 h), ceftriaxone (2 gr/iv/12 h) and Vancomycin (1 gr/iv/12 hI).
The periocular inflammatory condition improved markedly in the first 24 hours, but not visual acuity, which was limited to the perception of patchy colors (blue, brown).
After 1 week, the prosthesis was removed negative, despite its good location and functioning, making a microbiological study of it and isolating three germs: Streptococcus oxysin bacillus, mitis.
During evolution, a pyocele that required left dacryocystectomy was developed.
At present, the patient has a vision of light perception in the left eye, with mild left-sided reactive mydriasis.
Fluorescein angiography shows papillary hypofluorescence throughout the angiogram, and MRI shows a doubtful late signal increase in the optic nerve.
