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Rapidly Progressive Orbital Mucopyocele Mimicking Pre-septal Cellulitis: A Diagnostic Challenge With Sight-Threatening Implications

Year: 2025

Type: article

Abstract: We present the case of a male patient in his 60s referred by his GP with mild, painless swelling of the left eyelid, initially suggestive of pre-septal cellulitis. Within 24 hours, the condition progressed rapidly to acute proptosis with marked lower eyelid ectropion. Examination revealed complete ophthalmoplegia with limitation in all axes of extraocular movement. CT imaging demonstrated a left frontal-anterior ethmoid mucopyocele with erosion of the frontal and ethmoidal walls, extending into the extraconal space of the left orbit and abutting the medial rectus at its scleral insertion. The patient underwent urgent endoscopic sinus surgery, including left frontal sinus trephination and lateral canthotomy for infection drainage. Rapid symptomatic improvement followed. Microbiological analysis confirmed Haemophilus influenzae as the causative organism. The patient was commenced on outpatient intravenous antibiotics, with ophthalmology follow-up arranged for lower eyelid repair. This case highlights the potential for mucopyocele to mimic pre-septal cellulitis and the risks of delayed imaging, which may lead to serious, vision-threatening complications.

Source: Cureus

DOI: 10.7759/cureus.99552

Authors: Harry Spencer, Gyleen Elegio, Hassan Elhassan

Institutions: Homerton University Hospital, Homerton University Hospital NHS Foundation Trust

Language: English

Topic: Otolaryngology and Infectious Diseases

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4417467121