-
Journal of the American College of... Dec 2022
PubMed: 36514537
DOI: 10.1002/emp2.12835 -
Ophthalmic Plastic and Reconstructive...A 66-year-old immunocompromised man presented with cellulitis around the left eye that was initially concerning for necrotizing fasciitis. Exam findings were remarkable...
A 66-year-old immunocompromised man presented with cellulitis around the left eye that was initially concerning for necrotizing fasciitis. Exam findings were remarkable for exquisite periocular tenderness with rigid, immobile eyelids resulting from severe erythema, edema, and induration. Given the concern for orbital compartment syndrome and a necrotizing infection, the patient was taken urgently to the operating room for debridement of the eyelid skin as well as an urgent lateral canthotomy and cantholysis. His eye exam revealed 360° of hemorrhagic chemosis, no relative afferent pupillary defect, and an ipsilateral elevated intraocular pressure of 35 mm Hg. No visual acuity measurement could be obtained secondary to the patient's altered mental status. His intraocular pressure normalized after treatment with antihypertensive drops and further extension of the canthotomy. Histopathological analysis showed extensive neutrophilic infiltrate of the dermis which was compatible with a diagnosis of Sweet's syndrome.
Topics: Male; Humans; Aged; Intraocular Pressure; Sweet Syndrome; Orbit; Cellulitis; Eyelids
PubMed: 36893059
DOI: 10.1097/IOP.0000000000002373 -
The Journal of Craniofacial Surgery Sep 2021The aim of the present study is to examine the effect of local administration of tranexamic acid (TXA) through lateral osteotomy line on postoperative periorbital edema...
INTRODUCTION
The aim of the present study is to examine the effect of local administration of tranexamic acid (TXA) through lateral osteotomy line on postoperative periorbital edema and ecchymosis.
MATERIALMETHOD
Thirty patients underwent open technical septorhinoplasty were included. Before lateral osteotomies, the surgeon opened narrow subperiosteal tunnels on the both sides. After lateral osteotomies, the surgeon irrigated TXA into the right tunnel with the broken tip of the injection and the same amount of saline into the left tunnel. The patient's photographs were taken on the first, third, and seventh postoperative days. Periorbital edema and ecchymoses were evaluated by the blinded author. The statistical differences between the 2 sides were analyzed.
RESULTS
Lower Eyelid Edema values were significantly lower in the TXA(+) group than the TXA(-) group on the third day (P = 0.001). There was no statistically significant difference between the sides in terms of lower eyelid edema values on the first and seventh days (P = 0.065, P = 0.317). Upper and lower eyelid ecchymosis values were significantly lower in TXA(+) group than TXA(-) group on the first, third, and seventh days (P < 0.05). Upper eyelid edema values were found to be significantly lower in the TXA(+) group than the TXA(-) group on the first and third days (P = 0.002, P = 0.005). There was no statistically significant between the sides in terms of upper eyelid edema (P = 0.315) on the seventh day.
CONCLUSIONS
It was observed in the present study that local administration of TXA in septorhinoplasty was effective in reducing postoperative periorbital edema and ecchymosis.Level of evidence: 2c.
Topics: Ecchymosis; Edema; Humans; Postoperative Complications; Rhinoplasty; Tranexamic Acid
PubMed: 33534311
DOI: 10.1097/SCS.0000000000007493 -
Current Opinion in Ophthalmology May 2021This review aims to bring together recent advances in basic, translational and clinical research on the pathogenesis and treatment of orbital inflammatory conditions. (Review)
Review
PURPOSE OF REVIEW
This review aims to bring together recent advances in basic, translational and clinical research on the pathogenesis and treatment of orbital inflammatory conditions.
RECENT FINDINGS
Basic science studies provide mechanistic insights into why the orbit is targeted for inflammation by autoimmune inflammatory disorders. Using Graves' disease as a test case reveals that endocrine pathways, such as the TSH and IGF1 receptor pathways play important roles in stimulating orbital inflammation. Furthermore, orbital tissues contain high concentrations of retinoids - byproducts of the visual pathway that diffuse across the sclera and can activate de novo transcription of inflammatory cytokines. Such cytokine expression places the orbit in a hyper-inflammatory 'resting' state, prone to respond to any additional systemic or local pro-inflammatory signals. The HIF2A--LOX pathway appears important for orbital tissue fibrosis. Lastly, bench-to-bedside studies of the IGF1R pathway have led to an FDA-approved drug, teprotumumab that represents a novel treatment approach for Graves' orbitopathy. Unfortunately, high drug costs and misplaced insurance company 'step-therapy' policies may block patients from receiving therapy that can protect vision and improve quality of life.
SUMMARY
Improved understanding of orbital inflammatory conditions has led to a new drug and promises additional breakthroughs. Translational research is successful, but requires time, resources, and patience.
Topics: Antibodies, Monoclonal, Humanized; Cytokines; Graves Ophthalmopathy; Hashimoto Disease; Humans; Inflammation; Orbital Cellulitis; Orbital Diseases; Orbital Myositis; Receptor, IGF Type 1; Receptors, Thyrotropin
PubMed: 33606408
DOI: 10.1097/ICU.0000000000000743 -
BMJ Case Reports Jul 2019
Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Coitus; Conjunctivitis, Bacterial; Gonorrhea; Humans; Levofloxacin; Male; Neisseria gonorrhoeae; Orbital Cellulitis; Photophobia; Treatment Outcome
PubMed: 31340941
DOI: 10.1136/bcr-2018-227787 -
Clinical Ophthalmology (Auckland, N.Z.) 2021COVID-19 infection is a respiratory disease but it can have ophthalmological manifestations as well. This study aimed to investigate the ophthalmological implications of...
BACKGROUND AND AIM
COVID-19 infection is a respiratory disease but it can have ophthalmological manifestations as well. This study aimed to investigate the ophthalmological implications of COVID-19 either during the course of the disease or after recovery.
METHODS
A retrospective study included the records of 425 COVID-19 patients, proved by positive PCR swabs. The records were collected from three isolation hospitals in Gharbeya Governorate, Egypt.
RESULTS
The mean age of the studied group was 41.73 ± 13.59, and 216 (50.8%) of them were males. One hundred and thirty one (30.8%) patients had ophthalmological manifestations. Among the entire patients, the most common ophthalmological presentation was conjunctivitis in 111 patients (26.1%), followed by neuro-retinal affection in 9 (2.1%), secondary fungal orbital cellulitis in 6 (1.4%), episcleritis in 3 (0.7%) and keratitis in 2 (0.5%) patients. All of the observed ophthalmological implications occurred either during the course of the disease (concurrent) or after recovery, except for the fungal orbital cellulitis which occurred only after recovery.
CONCLUSION
COVID-19 could cause different eye manifestations. Recovery from the main disease does not guarantee eye safety, especially in high-risk patients.
PubMed: 34819718
DOI: 10.2147/OPTH.S336600 -
Journal of General Internal Medicine Aug 2023Cellulitis is a clinical diagnosis with several mimics and no gold standard diagnostic criteria. Misdiagnosis is common. This review aims to quantify the proportion of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cellulitis is a clinical diagnosis with several mimics and no gold standard diagnostic criteria. Misdiagnosis is common. This review aims to quantify the proportion of cellulitis misdiagnosis in primary or unscheduled care settings based on a second clinical assessment and describe the proportion and types of alternative diagnoses.
METHODS
Electronic searches of Medline, Embase and Cochrane library (including CENTRAL) using MeSH and other subject terms identified 887 randomised and non-randomised clinical trials, and cohort studies. Included articles assessed the proportion of cellulitis misdiagnosis in primary or unscheduled care settings through a second clinical assessment up to 14 days post initial diagnosis of uncomplicated cellulitis. Studies on infants and patients with (peri-)orbital, purulent and severe or complex cellulitis were excluded. Screening and data extraction was conducted independently in pairs. Risk of bias was assessed using a modified risk of bias tool from Hoy et al. Meta-analyses were undertaken where ≥ 3 studies reported the same outcome.
RESULTS
Nine studies conducted in the USA, UK and Canada, including a total of 1600 participants, were eligible for inclusion. Six studies were conducted in the inpatient setting; three were in outpatient clinics. All nine included studies provided estimates of the proportion cellulitis misdiagnosis, with a range from 19 to 83%. The mean proportion misdiagnosed was 41% (95% CI 28 to 56% for random effects model). Heterogeneity between studies was very high both statistically (I 96%, p-value for heterogeneity < 0.001) and clinically. Of the misdiagnoses, 54% were attributed to three conditions (stasis dermatitis, eczematous dermatitis and edema/lymphedema).
DISCUSSION
The proportion of cellulitis misdiagnosis when reviewed within 14 days was substantial though highly variable, with the majority attributable to three diagnoses. This highlights the need for timely clinical reassessment and system initiatives to improve diagnostic accuracy of cellulitis and its most common mimics.
TRIAL REGISTRATION
Open Science Framework ( https://osf.io/9zt72 ).
Topics: Humans; Cellulitis; Diagnostic Errors; Canada
PubMed: 37231210
DOI: 10.1007/s11606-023-08229-w -
International Journal of Women's... Oct 2022
PubMed: 36249536
DOI: 10.1097/JW9.0000000000000051 -
Ophthalmic Plastic and Reconstructive...
Topics: Edema; Eye Diseases; Face; Humans
PubMed: 35420574
DOI: 10.1097/IOP.0000000000002192 -
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