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Current Opinion in Ophthalmology Sep 2019This study is a review of recent literature in the diagnosis and management of preseptal cellulitis, orbital cellulitis and dacryocystitis, including causative... (Review)
Review
PURPOSE OF REVIEW
This study is a review of recent literature in the diagnosis and management of preseptal cellulitis, orbital cellulitis and dacryocystitis, including causative organisms, diagnosis and medical or surgical therapy and potential complications.
RECENT FINDINGS
Advances in vaccination against Haemophilus influenzae B have resulted in a shift in the most common causative organisms of preseptal and orbital cellulitis. Management of orbital cellulitis has been advanced by adjuvant corticosteroids, and subperiosteal abscess volumes of more than 1250 ml has been shown as predictive for requiring potential surgical intervention.
SUMMARY
Periorbital infections require prompt evaluation and management. Although the infectious organisms in both preseptal and orbital cellulitis include Staphylococcus/Streptococcus species, management may differ significantly on the basis of the nidus of infection, presenting signs and symptoms, and response to initial medical management.
Topics: Abscess; Anti-Bacterial Agents; Bacteria; Child; Child, Preschool; Dacryocystitis; Eye Infections, Bacterial; Female; Humans; Male; Orbital Cellulitis
PubMed: 31261188
DOI: 10.1097/ICU.0000000000000589 -
Indian Journal of Ophthalmology May 2023After the global COVID-19 pandemic, there has been an alarming concern with the monkeypox (mpox) outbreak, which has affected more than 110 countries worldwide.... (Review)
Review
After the global COVID-19 pandemic, there has been an alarming concern with the monkeypox (mpox) outbreak, which has affected more than 110 countries worldwide. Monkeypox virus is a doublestranded DNA virus of the genus Orthopox of the Poxviridae family, which causes this zoonotic disease. Recently, the mpox outbreak was declared by the World Health Organization (WHO) as a public health emergency of international concern (PHEIC). Monkeypox patients can present with ophthalmic manifestation and ophthalmologists have a role to play in managing this rare entity. Apart from causing systemic involvement such as skin lesions, respiratory infection and involvement of body fluids, Monkeypox related ophthalmic disease (MPXROD) causes varied ocular manifestations such as lid and adnexal involvement, periorbital and lid lesion, periorbital rash, conjunctivitis, blepharocounctivitis and keratitis. A detailed literature review shows few reports on MPXROD infections with limited overview on management strategies. The current review article is aimed to provide the ophthalmologist with an overview of the disease with a spotlight on ophthalmic features. We briefly discuss the morphology of the MPX, various modes of transmission, an infectious pathway of the virus, and the host immune response. A brief overview of the systemic manifestations and complications has also been elucidated. We especially highlight the detailed ophthalmic manifestations of mpox, their management, and prevention of vision threatening sequelae.
Topics: Humans; COVID-19; Mpox (monkeypox); Pandemics; Eye; Body Fluids
PubMed: 37203020
DOI: 10.4103/ijo.IJO_2032_22 -
Journal of Cosmetic and Laser Therapy :... Nov 2020Soft tissue augmentation with injectable fillers is increasingly being performed, and providers must be prepared to understand and treat complications. Periorbital skin... (Review)
Review
Soft tissue augmentation with injectable fillers is increasingly being performed, and providers must be prepared to understand and treat complications. Periorbital skin presents unique challenges due to its thin nature, easily evident pigmentary and textural irregularities, and anatomical considerations including vasculature and subcutaneous layers. The most common complications of infraorbital filler include ecchymosis, malar edema, blue-gray hue, and contour irregularities. Uncommon complications include infection and biofilm formation, skin necrosis, and blindness. This purpose of this review is to highlight the infraorbital anatomy, complications of filler injection in this region, and techniques to avoid these complications.
Topics: Cosmetic Techniques; Dermal Fillers; Edema; Face; Humans; Hyaluronic Acid
PubMed: 33794721
DOI: 10.1080/14764172.2021.1909067 -
International Medical Case Reports... 2019Proptosis in children with acute-onset accompanied by signs of inflammation is commonly caused by orbital cellulitis, however, the possibility of rhabdomyosarcoma should... (Review)
Review
INTRODUCTION
Proptosis in children with acute-onset accompanied by signs of inflammation is commonly caused by orbital cellulitis, however, the possibility of rhabdomyosarcoma should always be considered by the clinician. This is a case report of a five-year-old boy presenting with an acute-onset of proptosis without a history of trauma and systemic infection. Our clinical differential diagnosis included orbital cellulitis and orbital rhabdomyosarcoma.
PURPOSE
To report a case of orbital cellulitis that clinically and radiologically mimics rhabdomyosarcoma.
CASE PRESENTATION
A five-year-old boy presented with rapid-onset proptosis, periorbital edema, pain and visual loss in the left eye for two weeks without a history of trauma, upper respiratory tract infection, sinusitis or immunosuppression. Our clinical differential diagnosis includes rhabdomyosarcoma and orbital cellulitis. Complete blood count reveals a leukocytosis. Multislice computed tomography (MSCT) scan shows lesions involving the lateral orbit and the retro bulbar space. Antibiotics combination and adjunct anti-inflammatory intravenously shows excellent clinical resolution.
CONCLUSIONS
The study demonstrates difficulty in differentiating acute orbital cellulitis from rhabdomyosarcoma based on clinical findings. In addition, the case highlights that antibiotic combination of cephalosporin and aminoglycosides together with an adjuvant corticosteroid as an anti-inflammatory was effective in the case of acute orbital cellulitis.
PubMed: 31692563
DOI: 10.2147/IMCRJ.S201678 -
Cureus Nov 2022Management of psychiatric disorders in high-risk cardiac patients often requires difficult decision making when it comes to acceptable medication side effects. We...
Management of psychiatric disorders in high-risk cardiac patients often requires difficult decision making when it comes to acceptable medication side effects. We present the case report of a 28-year-old female with a history of generalized anxiety disorder (GAD), major depressive disorder (MDD), intravenous heroin use disorder, and prior tricuspid valve replacement who presented to the hospital with signs and symptoms of sepsis. She was found to have corrected QT interval (QTc) prolongation and infective endocarditis with blood cultures positive for . Due to QTc prolongation, her home medication of citalopram was discontinued in favor of escitalopram. Within 24 hours of administration, the patient experienced angioedema with periorbital swelling, lip swelling, and urticaria of the face and arms which was resolved with intravenous (IV) diphenhydramine. In this case report, we present what we believe to be the first recorded case of escitalopram-induced angioedema in a patient without a past medical history of hereditary angioedema (HAE), and how pharmacogenomic testing influenced antidepressant medication selection.
PubMed: 36540519
DOI: 10.7759/cureus.31600 -
Ophthalmic Plastic and Reconstructive...Three patients presented with periorbital swelling, pain with extraocular movements, and binocular diplopia 1-4 days after receiving an mRNA Coronavirus Infectious...
Three patients presented with periorbital swelling, pain with extraocular movements, and binocular diplopia 1-4 days after receiving an mRNA Coronavirus Infectious Disease-19 (COVID-19) vaccine (BNT162b2, Pfizer/BioNTech; mRNA-1273, Moderna). All patients had a normal afferent function, unilateral limitation of extraocular motility, proptosis, and periorbital inflammation. Neuroimaging of the orbits with contrast revealed inflammation and enlargement of extraocular muscles in 2 cases and the lacrimal gland in 1 case. In all 3 cases, an extensive infectious and inflammatory laboratory work-up was unremarkable and signs and symptoms of orbital inflammation rapidly improved to complete resolution after treatment with high-dose oral prednisone. This is the first reported series of orbital inflammation occurring shortly after administration of the COVID-19 vaccine. Clinicians may consider an inflammatory postvaccine etiology as an alternative to presumed idiopathic diagnosis in such cases.
Topics: BNT162 Vaccine; COVID-19; COVID-19 Vaccines; Communicable Diseases; Humans; Inflammation; Vaccination
PubMed: 35323144
DOI: 10.1097/IOP.0000000000002161 -
Survey of Ophthalmology 2020Mohs micrographic surgery and reconstruction is considered by many as the gold standard for treatment of cutaneous malignancies arising in the periorbital region. It has... (Review)
Review
Mohs micrographic surgery and reconstruction is considered by many as the gold standard for treatment of cutaneous malignancies arising in the periorbital region. It has a high rate of tumor clearance and a low rate of postsurgical complications. One of the most common complications is surgical site infection. Although surgical site infection occurs in less than 3% of patients, it may result in significant morbidity. Considerable research efforts have been devoted to identifying risk factors associated with the development of a postsurgical infection. We examine the impact of endogenous factors (which determine the efficacy of a patient's immune system), exogenous factors (which influence a patient's exposure to bacterial pathogens), and antimicrobial interventions on the incidence of surgical site infection and propose evidence-based recommendations.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Eye Infections, Bacterial; Global Health; Humans; Incidence; Mohs Surgery; Surgical Wound Infection
PubMed: 31838049
DOI: 10.1016/j.survophthal.2019.12.001 -
The American Journal of Emergency... Jun 2023Orbital cellulitis is an uncommon but serious condition that carries with it a potential for significant morbidity. (Review)
Review
INTRODUCTION
Orbital cellulitis is an uncommon but serious condition that carries with it a potential for significant morbidity.
OBJECTIVE
This review highlights the pearls and pitfalls of orbital cellulitis, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
DISCUSSION
Orbital cellulitis refers to infection of the globe and surrounding soft tissues posterior to the orbital septum. Orbital cellulitis is typically caused by local spread from sinusitis but can also be caused by local trauma or dental infection. It is more common in pediatric patients compared to adults. Emergency clinicians should first assess for and manage other critical, sight-threatening complications such as orbital compartment syndrome (OCS). Following this assessment, a focused eye examination is necessary. Though orbital cellulitis is primarily a clinical diagnosis, computed tomography (CT) of the brain and orbits with and without contrast is critical for evaluation of complications such as abscess or intracranial extension. Magnetic resonance imaging (MRI) of the brain and orbits with and without contrast should be performed in cases of suspected orbital cellulitis in which CT is non-diagnostic. While point-of-care ultrasound (POCUS) may be useful in differentiating preseptal from orbital cellulitis, it cannot exclude intracranial extension of infection. Management includes early administration of broad-spectrum antibiotics and ophthalmology consultation. The use of steroids is controversial. In cases of intracranial extension of infection (e.g., cavernous sinus thrombosis, abscess, or meningitis), neurosurgery should be consulted.
CONCLUSION
An understanding of orbital cellulitis can assist emergency clinicians in diagnosing and managing this sight-threatening infectious process.
Topics: Adult; Child; Humans; Orbital Cellulitis; Abscess; Prevalence; Orbit; Ophthalmology; Anti-Bacterial Agents; Cellulitis; Orbital Diseases; Retrospective Studies
PubMed: 36893591
DOI: 10.1016/j.ajem.2023.02.024 -
Current Opinion in Ophthalmology Jun 2024To highlight the clinical features of mpox with an emphasis on ocular manifestations and to review treatment options for this re-emerging infectious disease.
PURPOSE OF REVIEW
To highlight the clinical features of mpox with an emphasis on ocular manifestations and to review treatment options for this re-emerging infectious disease.
RECENT FINDINGS
Ocular involvement of mpox varies by clade. The most recent 2022 outbreak appears to be associated with fewer conjunctivitis cases compared to previous outbreaks. However, the ocular findings occurring during this newly emerging clade can be visually threatening and include cases of keratitis, rapidly progressing scleritis, and necrotizing periorbital rashes.
SUMMARY
Ocular mpox is an important clinical feature of systemic mpox virus (MPXV) infection. Heightened clinical suspicion allows for a timely diagnosis and the initiation of antiviral treatment, when appropriate. Randomized clinical trials for mpox systemic and ocular treatment efficacy are lacking. Prior clinical experience with smallpox and in-vitro mpox data support the use of systemic antivirals such as tecovirimat, cidofovir, brincidofovir and topical use of trifluridine in ocular mpox management, though treatment-resistant infection can occur and portend a poor prognosis.
PubMed: 38847744
DOI: 10.1097/ICU.0000000000001066