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Indian Journal of Pathology &... Jul 2023We report an unusual presentation of an orbital spindle cell hemangioma in a 40-year-old male, who noted sudden redness and swelling of the left eye on waking up. On...
We report an unusual presentation of an orbital spindle cell hemangioma in a 40-year-old male, who noted sudden redness and swelling of the left eye on waking up. On examination, the patient was found to have edema of upper eyelid edema, periorbital ecchymosis, and subconjunctival hemorrhage in the left eye at presentation. On treatment with topical medications, patient had transient symptomatic relief; however, he later developed blurring of vision. When seen 10 days later, the patient's left eye showed axial proptosis. Radiological investigations revealed an intraconal soft tissue mass in the left medial rectus. Emergency orbital decompression with mass excision was done; histopathological examination of the excised mass revealed spindle cell hemangioma. Postsurgery patient had complete restoration of vision. To our knowledge, an acute presentation of an orbital hemangioma with subconjunctival hemorrhage and periorbital ecchymosis, visual loss doesn't occur commonly; hence, such presentations have to be reviewed with care.
PubMed: 38391307
DOI: 10.4103/ijpm.ijpm_948_22 -
Advances in Therapy Sep 2023Dupilumab is a drug that inhibits the action of interleukin (IL)-4 and IL-13 and is a potent therapeutic drug for allergic diseases such as atopic dermatitis. Although...
INTRODUCTION
Dupilumab is a drug that inhibits the action of interleukin (IL)-4 and IL-13 and is a potent therapeutic drug for allergic diseases such as atopic dermatitis. Although its use has been associated with significant ocular adverse drug reactions (ADRs), the IL-4 and IL-13 inhibition may also have favorable therapeutic effects. The aim of this study was to determine the disease spectrum in which the use of dupilumab may have been associated with an increase or decrease of ocular ADRs.
METHODS
We searched the World Health Organization's VigiBase for ADRs associated with the use of dupilumab for data up to 12 June 2022. The number of all ADRs that were retrieved was compared with the number of ocular ADRs associated with the use of dupilumab. Disproportionate reporting was assessed by calculating the information component (IC) values and odds ratios.
RESULTS
Since the introduction of dupilumab, 100,267 ADRs have been reported. Of all the ADRs associated with dupilumab, 28,522 ADRs were ocular complications, and it ranked fourth in the ocular complications by organ level. By assessments of the IC for age ≤ 44 years, the most significantly associated ADRs were dry eye followed by blepharitis including eyelid crusting and dryness and conjunctivitis. Crusting and dryness of the eyelids were the most significant ADRs for all age groups. Other ocular ADRs reported include meibomian gland dysfunction, keratitis, glaucoma, and retinal disorders. In contrast, periorbital edema, neuro-ophthalmic disorders, optic neuritis, and macular edema were significantly reduced by the use of dupilumab.
CONCLUSIONS
Dupilumab-related ADRs included an increase or decrease of various ocular disorders. The results indicate that dupilumab also has potential therapeutic effects.
Topics: Humans; Adult; Interleukin-13; Drug-Related Side Effects and Adverse Reactions; Dry Eye Syndromes; World Health Organization
PubMed: 37358706
DOI: 10.1007/s12325-023-02573-3 -
Microbiological Research Aug 2023Antibiotic resistance is growing as a critical challenge in a variety of disease conditions including ocular infections leading to disastrous effects on the human eyes.... (Review)
Review
Antibiotic resistance is growing as a critical challenge in a variety of disease conditions including ocular infections leading to disastrous effects on the human eyes. Staphylococcus aureus (S. aureus) mediated ocular infections are very common affecting different parts of the eye viz. vitreous chamber, conjunctiva, cornea, anterior and posterior chambers, tear duct, and eyelids. Blepharitis, dacryocystitis, conjunctivitis, keratitis, endophthalmitis, and orbital cellulitis are some of the commonly known ocular infections caused by S. aureus. Some of these infections are so fatal that they could cause bilateral blindness like panophthalmitis and orbital cellulitis, which is caused by methicillin-resistant S. aureus (MRSA) and vancomycin-resistance S. aureus (VRSA). The treatment of S. aureus infections with known antibiotics is becoming gradually difficult because of the development of resistance against multiple antibiotics. Apart from the different combinations and formulation strategies, bacteriophage therapy is growing as an effective alternative to treat such infections. Although the superiority of bacteriophage therapy is well established, yet physical factors (high temperatures, acidic pH, UV-rays, and ionic strength) and pharmaceutical barriers (poor stability, low in-vivo retention, controlled and targeted delivery, immune system neutralization, etc.) have the greatest influence on the viability of phage virions (also phage proteins). A variety of Nanotechnology based formulations such as polymeric nanoparticles, liposomes, dendrimers, nanoemulsions, and nanofibres have been recently reported to overcome the above-mentioned obstacles. In this review, we have compiled all these recent reports and discussed bacteriophage-based nanoformulations techniques for the successful treatment of ocular infections caused by multidrug-resistant S. aureus and other bacteria.
Topics: Humans; Methicillin-Resistant Staphylococcus aureus; Staphylococcus aureus; Orbital Cellulitis; Anti-Bacterial Agents; Eye Infections, Bacterial; Staphylococcal Infections; Nanotechnology; Microbial Sensitivity Tests
PubMed: 37216845
DOI: 10.1016/j.micres.2023.127413 -
Orbit (Amsterdam, Netherlands) Dec 2023A 66-year-old man presented with chronic bilateral periorbital edema with associated yellowish hue, scattered violaceous smooth macules and contracture of the forehead....
A 66-year-old man presented with chronic bilateral periorbital edema with associated yellowish hue, scattered violaceous smooth macules and contracture of the forehead. He had undergone dental surgery 3 months prior to symptom onset. Laboratory workup for common causes of eyelid edema was unremarkable and MRI of the orbits was unrevealing. The patient did not respond to oral corticosteroids or antibiotics. Punch biopsies were obtained which revealed atypical lymphatic endothelial cells consistent with a diagnosis of cutaneous angiosarcoma.The patient was deemed not to be a surgical candidate and underwent 3 cycles of immunotherapy with limited response. He declined further treatment and transitioned to hospice care. Although cutaneous angiosarcoma uncommonly involves the periorbital region, it should be considered in the differential diagnosis of eyelid edema as early recognition and treatment are critical to prevent rapid intradermal spread and metastases.
Topics: Male; Humans; Aged; Hemangiosarcoma; Endothelial Cells; Skin Neoplasms; Edema
PubMed: 35467482
DOI: 10.1080/01676830.2022.2056901 -
HNO Feb 2024Sinogenic orbital complications in children are relatively rare but critical conditions that require accurate diagnosis and timely appropriate treatment to prevent... (Review)
Review
BACKGROUND
Sinogenic orbital complications in children are relatively rare but critical conditions that require accurate diagnosis and timely appropriate treatment to prevent severe sequelae.
OBJECTIVE
This article concentrates on clinical, diagnostic, and therapeutic specifics of sinogenic orbital complications in children.
MATERIALS AND METHODS
The work is based on a literature review (PubMed, Google Scholar) and own experience as well as data from the authors' own pediatric population.
RESULTS
In children, sinogenic orbital complications are usually secondary due to acute bacterial sinusitis. Correct distinction between pre- and postseptal cellulitis is of utmost importance for correct diagnostic and therapeutic management in order to prevent long-term sequelae. Preseptal cellulitis can be treated conservatively. If there are signs of postseptal involvement, prompt cross sectional imaging will be required. Depending on the severity of the postseptal involvement, surgical treatment may be necessary.
CONCLUSION
Recent literature debates three main issues: 1) developing models for different combinations of symptoms that reliably distinguish between pre- and postseptal cellulitis; 2) selection of appropriate cross-sectional imaging (MRI vs. CT); and 3) indications for surgery. All three issues will be discussed in detail in this article.
PubMed: 38349568
DOI: 10.1007/s00106-024-01421-2 -
Neuroimaging Clinics of North America Nov 2023Most primary orbital pathology in children is due to bacterial infection. Radiologists typically encounter these cases to evaluate for clinically suspected postseptal... (Review)
Review
Most primary orbital pathology in children is due to bacterial infection. Radiologists typically encounter these cases to evaluate for clinically suspected postseptal orbital involvement. Contrast-enhanced cross-sectional imaging is important for the detection and early management of orbital infection and associated subperiosteal/orbital abscess, venous thrombosis, and intracranial spread of infection. Benign mass-like inflammatory processes involving the pediatric orbit are rare, have overlapping imaging features, and must be distinguished from orbital malignancies.
Topics: Child; Humans; Orbit; Sinusitis; Tomography, X-Ray Computed; Orbital Cellulitis; Radiologists; Orbital Diseases
PubMed: 37741666
DOI: 10.1016/j.nic.2023.05.015 -
The Journal of Craniofacial SurgeryPeriorbital edema and ecchymosis that may occur after surgery in septorhinoplasty patients who have undergone lateral osteotomy are common morbidities and are seen as...
PURPOSE
Periorbital edema and ecchymosis that may occur after surgery in septorhinoplasty patients who have undergone lateral osteotomy are common morbidities and are seen as the main limiting factors for the recovery process of the patients. There are many different studies in the literature about the causes of periorbital edema and ecchymosis. In this study, the authors aimed to investigate the possible relationships between the bone density and bone thickness measured in the frontal process of the maxillary bone, and postoperative periorbital edema and ecchymosis, which are suitable for the osteotomy lines that they will detect in computerized tomography.
METHODS
Between January 1, 2019 and November 11, 2020, 59 patients whose nasal pathologies were determined by paranasal sinus computed tomography examination due to nasal deformity and nasal deformity and who underwent septorhinoplasty operation were included in this study. Bone density and thickness measurements were performed on the frontal process of the maxillary bone in accordance with the lateral osteotomy lines on the lateral nasal wall in each patient, right and left side. According to the bone density values measured at the point determined on the lateral osteotomy line, 2 groups were formed as "very dense" and "less dense." According to the bone thickness values of the patients, 2 groups were determined as "thick" and "thin." Thus, the authors investigated the relationship between periorbital edema and ecchymosis on the postoperative first, third, and seventh days obtained from the examination files of the patients.
FINDINGS
When bone density subgroups are examined, it has been shown that the degree of periorbital edema of the patients in the "very dense" and "less dense" group categories decreased from the first day to the seventh postoperative day. The degrees of periorbital edema on the third postoperative day were statistically higher in the "less dense" group than in the "very dense" group. In the authors' study, no correlation was found between the degrees of postoperative periorbital edema and ecchymosis and bone density subgroups on other days. While an increase was observed in the periorbital ecchymosis grades of the patients in the "less dense" subgroup category from the first day to the third postoperative day, the periorbital ecchymosis grades of the patients in the "very dense" subgroup category decreased from the first day to the third day. In both subgroups, the lowest periorbital ecchymosis levels were observed on the postoperative seventh day.When bone thickness subgroups are examined, it has been shown that the degree of periorbital edema of the patients in the "thick" and "thin" group categories decreases from the first day to the seventh day postoperatively. When the bone thickness subgroups were examined, the periorbital ecchymosis degrees of the patients in the "thick" and "thin" group categories increased on the third postoperative day, while it reached the lowest level on the postoperative seventh day. There was no significant difference between the first, third, and seventh-day periorbital edema and ecchymosis conditions in the "thick" and "thin" groups.
CONCLUSION
The authors observed that periorbital edema and ecchymosis that may occur after septorhinoplasty can be affected by the variable features of the lateral nasal wall bone structure. The authors conclude that the changes in the healing process can be affected by different bone density values in particular.
Topics: Humans; Ecchymosis; Bone Density; Edema; Rhinoplasty; Eye Diseases; Osteotomy; Postoperative Complications
PubMed: 38011627
DOI: 10.1097/SCS.0000000000009848 -
The Journal of Craniofacial SurgeryTo investigate the benefit of preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in predicting early postoperative periorbital edema and...
PURPOSE
To investigate the benefit of preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in predicting early postoperative periorbital edema and ecchymosis in patients undergoing primary septorhinoplasty.
METHODS
Sixty patients in ASA-I (American Society of Anesthesiologists) who were scheduled for elective primary septorhinoplasty were prospectively included in the study. Periorbital edema and ecchymosis levels of the patients were scored on the postoperative second day. The relationship between early postoperative periorbital edema and ecchymosis levels and preoperative neutrophil, lymphocyte, platelet, NLR, and PLR values were investigated.
RESULTS
The mean age of the 60 patients was 24.05 ± 6.83 years. The patients were divided into 2 groups according to the total periorbital edema scores in both eyes on the second day after surgery. There was no significant difference between the two groups in terms of neutrophil, platelet, and NLR ( P > 0.05). In addition, the lymphocyte count was found to be statistically significantly lower and PLR significantly higher in the group with high edema scores ( P < 0.05). When the patients were divided into groups according to their periorbital ecchymosis scores, no significant correlation was found between any blood values and periorbital ecchymosis ( P > 0.05).
CONCLUSION
Preoperative PLR may be used to predict early postoperative periorbital edema in patients undergoing primary rhinoplasty. However, a blood value that can predict periorbital ecchymosis has not been determined yet.
Topics: Humans; Adolescent; Young Adult; Adult; Ecchymosis; Rhinoplasty; Neutrophils; Postoperative Complications; Edema; Eye Diseases; Lymphocytes
PubMed: 36631945
DOI: 10.1097/SCS.0000000000009169 -
Seminars in Arthritis and Rheumatism Jun 2024VEXAS syndrome is a recently described monogenic autoinflammatory disease capable of manifesting itself with a wide array of organs and tissues involvement....
VEXAS syndrome is a recently described monogenic autoinflammatory disease capable of manifesting itself with a wide array of organs and tissues involvement. Orbital/ocular inflammatory manifestations are frequently described in VEXAS patients. The objective of this study is to further describe orbital/ocular conditions in VEXAS syndrome while investigating potential associations with other disease manifestations. In the present study, twenty-seven out of 59 (45.8 %) VEXAS patients showed an inflammatory orbital/ocular involvement during their clinical history. The most frequent orbital/ocular affections were represented by periorbital edema in 8 (13.6 %) cases, episcleritis in 5 (8.5 %) patients, scleritis in 5 (8.5 %) cases, uveitis in 4 (6.8 %) cases, conjunctivitis in 4 (6.8 %) cases, blepharitis in 3 (5.1 %) cases, orbital myositis in 2 (3.4 %) cases. A diagnosis of systemic immune-mediated disease was observed in 15 (55.6 %) cases, with relapsing polychondritis diagnosed in 12 patients. A significant association was observed between relapsing polychondritis and orbital/ocular involvement in VEXAS syndrome (Relative Risk: 2.37, 95 % C.I. 1.03-5.46, p = 0.048). Six deaths were observed in the whole cohort of patients after a median disease duration of 1.2 (IQR=5.35) years, 5 (83.3 %) of which showed orbital/ocular inflammatory involvement. In conclusion, this study confirms that orbital/ocular inflammatory involvement is a common finding in VEXAS patients, especially when relapsing polychondritis is diagnosed. This makes ophthalmologists a key figure in the diagnostic process of VEXAS syndrome. The high frequency of deaths observed in this study seems to suggest that patients with orbital/ocular involvement may require increased attention and more careful follow-up.
Topics: Humans; Male; Female; Adult; Registries; Middle Aged; Young Adult; Adolescent; Orbital Diseases; Hereditary Autoinflammatory Diseases; Eye Diseases; Child; Aged; Scleritis; Polychondritis, Relapsing
PubMed: 38554594
DOI: 10.1016/j.semarthrit.2024.152430 -
Cureus Jan 2024Periorbital emphysema is rare and associated with facial trauma. Its main distinguishing feature is crepitation on palpation of the edema. It resolves spontaneously in a...
Periorbital emphysema is rare and associated with facial trauma. Its main distinguishing feature is crepitation on palpation of the edema. It resolves spontaneously in a few days, but there are cases of orbital compartment syndrome that can lead to loss of vision. Here we present the case of a 55-year-old male who came to the emergency department for bilateral periorbital edema associated with non-steroidal anti-inflammatory drug (NSAID) usage, for pain following a fall from a ladder. He was treated with antihistamines and corticosteroids, for presumed allergic reaction, but without response, and subsequently developed acute onset dyspnea. Chest x-ray revealed a left pneumothorax in the context of chest trauma. Chest CT scan after drain placement shows extensive subcutaneous emphysema. In the differential diagnosis of periorbital edema, in addition to allergic, inflammatory, and systemic causes, the traumatic ones should not be excluded.
PubMed: 38187024
DOI: 10.7759/cureus.51691