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A 23-year-old nurse working in a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ward presented with a 1-week history of left upper brow and eyelid swelling and discharge from the upper brow. She had manicured her eyebrows with tweezers approximately 1 month before, but denied other trauma, sinus symptoms, or prior use of an eyebrow ring. She was clinically diagnosed with an eyelid abscess and started on trimethoprim/sulfamethoxazole and amoxicillin/clavulanic acid. Computed tomography imaging was not performed because the physical examination demonstrated only superficial findings.
On further history, she used protective goggles (Fig. 1), which she cleaned with hospital wipes (Super Sani-Cloth Germicidal Disposable Wipes, PDI Healthcare) that contained ingredients including quaternary ammonium and 55.5% isopropyl alcohol. During local anaesthetic injection for incision and drainage, a track to the brow was noted that terminated at a small scab (Fig. 2), corresponding to the initial site of her swelling. It is postulated that cleansing of the goggles with a dermatoxic substance, and chronic pressure from the goggles may have inadvertently contributed to skin breakdown. The tight seal over the original site of drainage may have created a nidus for bacterial growth that led to abscess formation. This case demonstrates the need for caution when using hospital-grade cleansing agents near the relatively thin and delicate eyelid and periorbital skin.
Footnotes and Disclosure
The authors have no proprietary or commercial interest in any materials discussed in this article.