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Ophthalmic Plastic and Reconstructive...A 62-year-old man presented with diffuse, painless, left-sided preseptal edema, erythema, and woody induration extending to the left temple. The induration generated an...
A 62-year-old man presented with diffuse, painless, left-sided preseptal edema, erythema, and woody induration extending to the left temple. The induration generated an orbital compartment syndrome with markedly elevated intraocular pressure necessitating lateral canthotomy and cantholysis. Although atypical for an infectious etiology, empiric broad-spectrum intravenous antibiotics were initiated with no improvement. A tissue biopsy demonstrated extensive perivascular and interstitial eosinophils with focal flame figures, and the patient was diagnosed with a severe hypersensitivity reaction or eosinophilic cellulitis (Wells syndrome). The disease process remitted rapidly upon initiation of oral prednisone. Wells syndrome is a rare inflammatory eosinophilic dermatosis, most often presenting in the limbs and trunk, with few reports of facial and periorbital involvement. This case highlights the importance of considering Wells syndrome in the differential diagnosis of atypical periorbital cellulitis that is nonresponsive to antibiotics and reviews the clinicopathologic nature of this disease.
Topics: Male; Humans; Middle Aged; Cellulitis; Eosinophilia; Eyelid Diseases; Anti-Bacterial Agents
PubMed: 35699219
DOI: 10.1097/IOP.0000000000002220 -
Indian Journal of Ophthalmology Jul 2022
Topics: Humans; Orbital Cellulitis; Orbital Neoplasms; Rhabdomyosarcoma
PubMed: 35791230
DOI: 10.4103/ijo.IJO_79_22 -
Romanian Journal of Ophthalmology 2023Odontogenic sinusitis is a well-known, but under-studied bacterial infection of the maxillary sinus that can extend to other sinuses, the orbit, or even the...
Odontogenic sinusitis is a well-known, but under-studied bacterial infection of the maxillary sinus that can extend to other sinuses, the orbit, or even the endocranium. We performed an observational retrospective study on the patients with odontogenic sinusitis treated in our hospital over a five-year period. We included patients over 18 years old diagnosed with odontogenic sinusitis and ocular complications and we excluded patients with ocular complications nonrelated to dental-originated sinusitis or patients with odontogenic sinusitis without orbital-ocular complications. We examined the charts of 46 patients. From the total number of patients with oculo-orbital complications generated by odontogenic sinusitis, only 7 were women. The mean age was 33,7 with a standard deviation of 15,7 years. The oculo-orbital complications were assessed according to the Chandler classification. The most frequent orbital complication was preseptal cellulitis followed by orbital cellulitis. All the patients were treated with antibiotic covering both anaerobic and aerobic bacteria and 40 of the patients in our study received surgical treatment. The outcomes were favorable for all the patients in our study with clinical resolution. The oculo-orbital complications of odontogenic sinusitis are severe because they can result in vision loss or other ocular sequelae. The bacteriological features of this sinusitis explain the special characteristics of this infection and can facilitate the extent of the infection to the orbit. Prompt intervention with antibiotics covering anaerobic and aerobic bacteria and surgery addressed to the affected sinus/ sinuses, the dental disease and the orbital pathology ensures a big success rate in the therapy of these complications.
PubMed: 37522025
DOI: 10.22336/rjo.2023.30 -
Brazilian Journal of Otorhinolaryngology 2022The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis.
OBJECTIVE
The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome.
METHODS
We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group.
RESULTS
Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD=-4.02 [-7.93; -0.12], p-value=0.04, I=96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR=0.78 [0.27; 2.23], p-value=0.64, I=0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group.
CONCLUSION
Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.
Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Cellulitis; Humans; Inflammation; Orbital Cellulitis; Orbital Diseases; Retrospective Studies; Steroids
PubMed: 33722520
DOI: 10.1016/j.bjorl.2021.02.003 -
Indian Journal of Ophthalmology Apr 2022Dirofilariasis is an emerging zoonosis in India. Most of the cases from India have been reported from the states of Kerala, coastal Karnataka and Maharashtra, and a few...
BACKGROUND
Dirofilariasis is an emerging zoonosis in India. Most of the cases from India have been reported from the states of Kerala, coastal Karnataka and Maharashtra, and a few from the North India, Orissa and Assam. Dogs, cats, foxes and other wild animals are definitive hosts for dirofilaria. Human ocular parasitosis is prevalent in geographical areas where environmental factors and poor sanitary conditions favor parasitism between humans and animals. However, in recent years, migrating population have facilitated the spread of certain parasitic diseases from endemic to non-endemic areas. We report a case of subconjunctival dirofilariasis in a 91-year-old man, who presented with features of orbital cellulitis. An intact live worm, measuring 13.5 cm, was extracted from the subconjunctival space, following which there was prompt resolution of symptoms.
PURPOSE
Given the increase in the frequency of dirofilariasis in humans in recent years, medical practitioners should bear in mind the possibility of ocular dirofilariasis when a patient presents with an ocular or orbital inflammatory lesion.
SYNOPSIS
This video illustrates various presentations of ocular dirofilaria and surgical extraction of a live worm from the subconjunctival space.
HIGHLIGHTS
Lifecycle and human ocular manifestations of dirofilaria ared elucidated. Rare presentation of subconjunctival dirofilariasis as orbital cellulitis and its resolution following removal of the live worm has been demonstrated.
VIDEO LINK
https://youtu.be/Nj8unz0S85M.
Topics: Aged, 80 and over; Animals; Conjunctiva; Dirofilaria; Dirofilariasis; Humans; India; Male; Orbital Cellulitis
PubMed: 35326084
DOI: 10.4103/ijo.IJO_630_22 -
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 -
Orbit (Amsterdam, Netherlands) Dec 2022To report the microbiologic profile and antibiotic susceptibility trends in orbital cellulitis.
PURPOSE
To report the microbiologic profile and antibiotic susceptibility trends in orbital cellulitis.
METHODS
Retrospective review of microbiology records of orbital cellulitis between 2005 and 2019. Orbital pus or conjunctival swab underwent culture for bacteria and fungi and antibiotic susceptibility testing for bacterial isolates. The microbiological profile and trends in antibiotic susceptibility were analyzed over the three study periods: 2005-2009, 2010-2014, and 2015-2019.
RESULTS
Of the 203 patient samples, 189 (93%) were orbital pus samples, and 146 (72%) were culture positive. Organisms included bacteria (167/203, 82.3%), fungi (13/203, 6.4%), and mixed infection (25/203, 10.3%). Among bacteria, 79% were gram positive, with species being commonest, and 21% were gram negative, with and group being the commonest. was the most common fungus isolated. Trend analysis revealed no change in the number of sterile cases and fungal cellulitis. Increase in gram positive bacteria was statistically significant ( = .0002) between 2005-2009 and 2015-2019. The increase in gram negative bacteria was statistically significant ( = .047) between all three time periods. Susceptibility patterns showed increasing trend of resistance to fluoroquinolones, that reached statistical significance for Ciprofloxacin, Moxifloxacin and Gatifloxacin ( < .05). Sterile sample was not found in any of the pediatric (0-16 years) cases (n = 55), compared to 28% in adults.
CONCLUSION
There was a significant rise in gram positive and negative orbital infections over the 15 year period, with increased resistance to fluoroquinolones. Fungal cellulitis and sterile samples showed a steady trend. Orbital aspirate provides accurate detection of the causative organism.
Topics: Adult; Child; Humans; Orbital Cellulitis; Microbial Sensitivity Tests; Fluoroquinolones; Bacteria; Anti-Bacterial Agents; Retrospective Studies
PubMed: 34939530
DOI: 10.1080/01676830.2021.2002368 -
Facial Plastic Surgery : FPS Oct 2020Skin problems following rhinoplasty may cause dissatisfaction concerning the esthetic expectations of the patients. This study was conducted to determine whether nasal...
Skin problems following rhinoplasty may cause dissatisfaction concerning the esthetic expectations of the patients. This study was conducted to determine whether nasal skin type has an effect on skin problems after rhinoplasty. Thirty-five patients undergoing rhinoplasty in our tertiary referral center between May 2018 and August 2019 were included in the study. The nasal skin sebum level was measured with Sebumeter preoperatively and patients were divided into two groups according to the median sebum level. Among the 35 patients, half of them with higher nasal skin sebum were categorized as oily skin group ( = 17; 14 males, 3 females; mean sebum level: 200.3 ± 26.9), and the other half were categorized as dry skin group ( = 18; 10 males, 8 females; mean sebum level: 101.9 ± 38). Periorbital edema and ecchymosis were assessed at postoperative days 1, 3, and 7. Acne and seborrhea severity determined with Global Acne Grading System and Seborrheic Dermatitis Area Severity Index the day before operation and postoperative days 7 and 14 and months 1, 3, and 10. Compared with dry skin group, upper eyelid ecchymosis score at postoperative day 7 was statistically higher in oily skin group ( = 0.044). There was no significant difference in upper eyelid edema scores between postoperative days 1 and 3 for oily skin group ( = 0.020). No statistically significant differences were found for acne and seborrhea severity. Nasal skin sebum levels may affect periorbital edema and ecchymosis after the procedure but no significant effect has been observed for acne and seborrhea. Predicting the effect of nasal skin types on these problems may help the surgeon to inform patients more correctly.
Topics: Ecchymosis; Edema; Esthetics, Dental; Female; Humans; Male; Postoperative Complications; Rhinoplasty
PubMed: 32717761
DOI: 10.1055/s-0040-1713792 -
Orbit (Amsterdam, Netherlands) Oct 2022A 6-month-old female presented with bilateral periorbital edema for 7 days. Laboratory testing was significant for active SARS-CoV-2 infection. Neuroimaging demonstrated...
A 6-month-old female presented with bilateral periorbital edema for 7 days. Laboratory testing was significant for active SARS-CoV-2 infection. Neuroimaging demonstrated soft tissue changes within the bilateral orbits and enlargement of the bilateral lacrimal glands. Although the patient initially improved with corticosteroid treatment, she later returned with recurrent left periorbital and eyelid edema. Orbital biopsy was performed and demonstrated findings in the lacrimal gland and the adjacent fibroconnective tissues that are similar to those of prior lung specimens seen in SARS-CoV-2 patients. Final diagnosis was bilateral orbital inflammation with features presumed secondary to SARS-CoV-2 infection. To the best of our knowledge, this is one of the first reports to document bilateral orbital inflammation as a sign of SARS-CoV-2 infection in the pediatric population with the associated pathological findings.
Topics: COVID-19; Child; Edema; Female; Humans; Infant; Inflammation; Lacrimal Apparatus; SARS-CoV-2
PubMed: 33874837
DOI: 10.1080/01676830.2021.1914670 -
Journal of Pediatric Neurosciences 2020An 8-month-old girl presented with fever, restricted left eye movements and increasing proptosis for 8 days. On examination she had left orbital cellulitis, relative...
An 8-month-old girl presented with fever, restricted left eye movements and increasing proptosis for 8 days. On examination she had left orbital cellulitis, relative afferent pupillary defect and ophthalmoplegia. Contrast-enhanced magnetic resonance imaging (MRI) brain with orbits revealed orbital apex syndrome (OAS) with cavernous sinus thrombosis. Orbital apex is located posteriorly in the orbit and characterised by involvement of cranial nerves II, III, IV, VI and ophthalmic division of Vth nerve. The close clinico-anatomical differentials of OAS are cavernous sinus and superior orbital fissure syndrome. The current case was treated successfully with intravenous antibiotics and anticoagulation therapy.
PubMed: 33531965
DOI: 10.4103/jpn.JPN_114_20