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Cerebrospinal Fluid in the Upper Eyelid An “Abscess” of a Different Kind

Leonard Goussard Heydenrych, FCOphth (SA), FRCOphth1; Colleen Michelle Aldous, PhD2; Roy Giles, FCRad (SA)3; Grant Andre du Plessis, MMED Neurosurg (Stell)3; Burnet Meyer, MMED Ophth (Stell), FCS (SA)4
[+] Author Affiliations
1Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
2Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
3Panorama Mediclinic, Cape Town, South Africa
4Cape Eye Hospital, Cape Town, South Africa
JAMA Ophthalmol. 2014;132(12):1485-1486. doi:10.1001/jamaophthalmol.2014.2866.
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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.

Article InformationCorresponding Author: Colleen Michelle Aldous, PhD, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Rd, Durban, South Africa (aldousc@ukzn.ac.za).

Published Online: August 21, 2014. doi:10.1001/jamaophthalmol.2014.2866.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

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Figure 1.
Magnetic Resonance Image Demonstrating Fistula Extending Between Intracranial Space and Orbital Collection

Sagittal T2-weighted short tau inversion recovery magnetic resonance imaging shows a white collection of cerebrospinal fluid in the superior aspect of the right orbit as well as a suspected breach in the roof of the orbit and communication in the cerebrospinal fluid space by means of a fistula (arrowhead) between the intracranial space and the orbital collection.

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Figure 2.
Aspiration of Cerebrospinal Fluid From the Upper Eyelid

Twenty milliliters of clear cerebrospinal fluid was aspirated from the right upper eyelid at the area of maximal fluctuation with a 21-gauge needle and syringe. Twelve hours later, the swelling reappeared and another 20 mL of clear fluid was drained.

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