Visual loss following orbital cellulitis can still occur despite prompt diagnosis and management. The development of retinal and/or ciliary artery occlusion following orbital cellulitis has not been well documented.1,2,3 We report a case of rapidly progressive staphylococcal orbital cellulitis resulting in a central retinal artery occlusion.

Intravenous acetazolamide, ocular massage and anterior chamber paracentesis were unsuccessful at restoring retinal perfusion. His left visual acuity deteriorated to no perception of light. Magnetic resonance imaging and computerized tomography demonstrated soft tissue density infiltrate extending anteriorly around the left globe with no sub-periosteal abscess, clear sinuses and no intracranial involvement. Both swab and fine-needle aspiration taken for the pustular lesion at the inner aspect of the left upper lid grew Staphylococcus aureus and his orbital cellulitis responded to intravenous flucloxacillin and metronidazole. Full blood count revealed only an increase in neutrophils and monocytes during the acute illness with inflammatory markers returning to normal after the infection had resolved. Immunological and haematological investigations were all normal. His past medical history and review of systems were noncontributory. There was no evidence clinically and from investigation that he was immunocompromised. His fundus fluorescein angiogram 1 week after the event confirmed his retinal vascular occlusion with normal choroidal perfusion (Figure 1d). Six weeks later, fundal examination did not demonstrate disturbances in the retinal pigment epithelium consistent with choroidal ischaemia.

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