Abscess on the eye
overview
An abscess on the eye creates an encapsulated cavity in the tissue that is filled with pus. The development of pus is a sign of an infection with bacteria, often caused by so-called staphylococci. The immune system reacts to this infection by sending special immune cells called white blood cells (leukocytes) to the site of the infection. These so-called neutrophils are responsible for fighting the invading bacteria. If pus then forms, it consists of a mixture of neutrophils, bacterial components and fragments of dead tissue cells from the area of the infection. Basically, this process makes sense and is a sign of a functioning immune response. However, if the pus cannot escape to the outside, a small cavity can form in the infected tissue, into which it drains. Later, a membrane forms around this pus-filled cavity: an abscess has formed and lodged in the tissue.
In principle, such a reaction can occur anywhere in the body where a bacterial infection occurs. This can happen inside or outside of the body. The skin and the underlying tissue are often affected, as pathogens from outside can quickly penetrate through the large surface of the skin. An abscess in the area of the face can be particularly disturbing, cosmetically and also due to its symptoms, and even dangerous. For example, if an abscess occurs in the eye, the symptoms can make blinking and sleeping difficult. When bacteria enter the lymphatic system or the blood, inflammation of the lymphatic system (lymphangitis) or blood poisoning (sepsis) can have serious consequences. If there is an abscess on the eye, it is particularly dangerous as it can quickly lead to serious and life-threatening complications.
Causes of an abscess on the eye
If an abscess appears on the eye in the area of the skin, it is often caused by an injury. The person concerned does not even have to remember one. Even small injuries, for example deep scratches or the squeezing of a pimple, can in the worst case be enough to allow bacteria to enter through the skin. An insect bite can also serve as a gateway for bacteria. However, larger injuries such as surgical wounds can of course also be responsible for the development of an infection and an abscess. In addition, foreign bodies, for example splinters of wood, can lead to an inflammatory reaction, pus formation and thus to an abscess on the eye.
The causes of an abscess on the eye can basically also be the ones mentioned. This is the case when a superficial infection spreads deeper. It is then called bacterial orbital phlegmon or orbital cellulitis. Other important causes of this are sinus inflammation (Sinusitis), the bags under the eyes (Dacrocystitis), the middle ear (otitis media) and the teeth. However, infections in remote areas, such as the airways, can also lead to the pathogens spreading to the area of the eye via the blood and the formation of an abscess.
Symptoms of an eye abscess
Basically, signs of inflammation appear with an abscess on the eye. The skin is supplied with more blood and is reddened as a result. In the area of the abscess, there is also a swelling, which is shown by a clear protrusion of the reddened, overheated skin to the outside. A feeling of tension arises. If you feel the skin over the abscess, you can feel the movement of the pus, the fluctuation. As part of the abscess, throbbing pain continues to occur in the affected area. The swelling and pain can also affect eyelid closure. In severe cases, so-called systemic symptoms can occur in addition to these localized symptoms, i.e. symptoms that indicate involvement of the entire body. Above all, this includes poor general well-being and fever.
Read more on the topic: Pus in the eye
If these symptoms occur, you should always see a doctor immediately as they indicate a severe course of the infection.
The same applies if warning symptoms appear as a sign of inflammation in the eye socket or an abscess in this area. These are: fever, severe pain in the eye, sudden deterioration in vision, protruding eyeball (exophthalmos) and paralyzed eye muscles with misalignment of the eye (ophthalmoplegia).
diagnosis
Basically important for the diagnosis of an abscess on the eye is the description of the patient in the medical discussion in which the medical history is recorded. In this so-called anamnesis discussion, the family doctor or ophthalmologist often learns important information that indicates the development of the abscess in the eye. If an abscess occurs in the area of the skin or subcutaneous tissue, the diagnosis can usually be made by simply looking. The characteristic reddening and swelling lead to the diagnosis. The doctor can also feel the moving pus under the skin by carefully touching the area with his fingers.
Examining the levels of inflammation in the blood and creating blood cultures can reveal systemic involvement.
If there is a suspicion of inflammation or an abscess in the eye socket due to the symptoms described by the patient, the eye must be examined in detail. The doctor then pays attention to redness and swelling (edema) around the eyeball, protruding of the eyeball and misalignment of the eye.
The above blood tests are also used in this case.
If the suspicion persists, a CT scan of the head may be necessary. With this, X-rays three-dimensional images are made, on which the spread of the inflammation in depth, the involvement of surrounding structures and the location of any abscesses can be assessed.
Treatment of an abscess on the eye
The principle "ubi pus, ibi evacua" ("Where there is pus, empty it") applies. This means that an abscess must always be opened surgically. This is relatively easy to see in the outer area of the eye. A small so-called stab incision is made, that is, a stab canal is created through which the pus is pushed out. The abscess cavity can then be rinsed with disinfecting solutions or table salt. In the case of deep abscesses, a disinfectant insert is placed in the abscess cavity to allow the pus to drain away.
Please also read: Surgery of an abscess.
Unfortunately, general anesthesia is often necessary for this small operation, as local anesthesia carries the risk of spreading bacteria in the tissue
Additional antibiotic treatment of the abscess does not necessarily have to be carried out. In the event of systemic symptoms or abnormal blood values, however, this should be carried out. Often, however, it is also used preventively after the abscess has been split.
The situation is somewhat different with an abscess that occurs in the area of the eye socket. In this area there is a risk of spreading into the brain. To avoid this, therapy must be given as soon as possible. First of all, the person concerned is admitted to the hospital as an in-patient. The first therapeutic step is the administration of antibiotics, at least initially mostly via a vein. If the therapy is sufficiently effective, it is usually carried out until the fever has not occurred for a few days. An existing abscess also requires surgery to drain the pus from the inaccessible area of the eye socket. This is done under general anesthesia either directly on the eye or indirectly via the upper jaw. The function of the eyes is also closely monitored during the inpatient stay.
Read more on this topic at: Treatment of an abscess
prophylaxis
Prevention of an abscess on the eye is possible within certain limits. After injuries these should be cleaned with a disinfectant suitable for skin disinfection. In many cases, this can prevent the triggering bacteria from growing there. Since the formation of abscesses is a complication of the infection in bacterial orbital phlegmon, this can often be prevented by early treatment of the underlying disease.
forecast
Treated early after there are no systemic symptoms, the prognosis for an abscess in the eye is good. He can mostly rapid healing to be brought. In this case, however, a doctor should be consulted quickly in order to avoid serious complications. If an abscess occurs in the eye socket, the initiation of treatment is crucial for the prognosis. With early therapy, the development of severe complications and long-term damage to the eyes and brain and life-threatening courses can usually be avoided. In the event of any doubt, a doctor should always be consulted immediately in order to influence the prognosis of the disease itself positively.
