Frontal osteomyelitis presenting as upper eyelid ectropion:
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Frontal osteomyelitis is a rare clinical entity that can occur as sequelae to frontal sinusitis, head trauma, as a postoperative complication following sinus surgery or due to haematogenous spread. It usually presents with a soft, fluctuant forehead swelling with pain and fever. Cicatricial ectropion is an extremely rare feature of frontal osteomyelitis.

Published in the Saudi Journal of Ophthalmology, the authors present a case of young male patient presenting with cicatricial ectropion that occurred as the sole manifestation of an underlying frontal osteomyelitis.

A seven year old boy, presented with the complaint of an upturned left upper lid for the past four months. The left upper lid had a cicatricial ectropion, with adherence of the upper lid to a scarred area adjacent to the eye brow. The scar was adherent to the underlying bone and a small sinus was noted in the scarred area with a drop of thick purulent discharge. The pus from the sinus was positive for Staphylococcus aureus and smear negative for acid fast bacilli.

A CT scan of brain and orbits revealed presence of irregular and patchy areas of sclerosis involving the outer table of the frontal bone on the left side with presence of a dense loose fragment, with irregular, sharply demarcated edges, lying within a cavity in the bone suggestive of sequestrum.

A diagnosis of chronic osteomyelitis of the skull was made. Bone windows showed the extent of bony destruction. Intracranial MR imaging ruled out intracranial involvement. The patient was started treatment with broad spectrum intravenous antibiotics and referred to neurosurgery where he is scheduled to undergo removal of the necrotic bone and drainage of the pus with continuation of parenteral antibiotics.

Key takeaway:-
Frontal osteomyelitis should be kept in mind as a possible etiology when considering the differential diagnosis of cicatricial ectropion.

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