Abstract
Objective
To describe the manifestations and treatment of extraocular muscle (EOM) bacterial
pyomyositis.
Design
A systematic review following PRISMA guidelines and a case report.
Methods
PubMed and MEDLINE databases were searched for case reports and case series of EOM
pyomyositis using the term “extraocular muscle” combined “pyomyositis” and “abscess”.
Patients were included as bacterial pyomyositis of the EOMs when there was a response
to antibiotics alone or if a biopsy was consistent with the diagnosis. Patients were
excluded when pyomyositis did not involve the EOMs or when diagnostic tests or treatment
were not in keeping with the diagnosis of bacterial pyomyositis. An additional patient
with bacterial myositis of the EOMs, treated locally, was added to the cases identified
in the systematic review. Cases were grouped for analysis.
Results
There are 15 published cases of EOM bacterial pyomyositis including the one reported
in this paper. Bacterial pyomyositis of the EOMs typically affects young males and
is caused by Staphylococcus species. Most patients present with ophthalmoplegia (12/15; 80%), periocular edema
(11/15; 73.3%), decreased vision (9/15; 60%) and proptosis (7/15; 46.7%). Treatment
involves antibiotics alone or in combination with surgical drainage.
Conclusions
Bacterial pyomyositis of the EOM presents with the same signs as orbital cellulitis.
Radiographic imaging identifies a hypodense lesion with peripheral ring enhancement
within the EOM. An approach to cystoid lesions of the EOMs is helpful in reaching
the diagnosis. Cases can be resolved with antibiotics aimed at treating Staphylococcus, and surgical drainage may be required.
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Article info
Publication history
Published online: February 27, 2023
Accepted:
February 2,
2023
Received in revised form:
February 1,
2023
Received:
March 3,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
