Supplementary Material for: Rare Case of Bilateral Orbital Cellulitis in An Adult, Caused by Enterococcus Faecalis

Orbital cellulitis is a serious life-threatening infection, typically in pediatric patients, and its bilateral presentation in adults is atypic. We present an unusual bilateral manifestation of orbital cellulitis and abscess, caused by Enterococci in an adult patient. E. faecalis is an extremely rare cause of orbital inflammation and we found three published case reports only, all of which are unilateral and seen in children. A 51-year-old male presented with one week history of pyrexia, painful proptosis, periorbital swelling and low vision of both eyes. He was diagnosed with bilateral orbital cellulitis and was treated with empiric antibiotic medication for 8 days, but symptoms persisted. MRI showed bilateral intra- and extraconal fluid-intensity collections. Microbiology was taken from the orbit and revealed Enterococcus faecalis invasion. Pus collections were drained for 1 week. Systemic and intraorbital antibiotics were administered. The patient recovered and vision returned to normal. This is a rare case of bilateral orbital cellulitis and abscesses with invasive E. faecalis infection. E. faecalis infection of the orbit is unusual and should be considered especially if patient does not respond to empiric antibiotic therapies.