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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 -
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 -
Medicine Jun 2021This study aims to identify predictive factors associated with surgical intervention and the visual outcome of orbital cellulitis and to evaluate the treatment...
This study aims to identify predictive factors associated with surgical intervention and the visual outcome of orbital cellulitis and to evaluate the treatment outcomes.A retrospective study involving 66 patients (68 eyes; 64 unilateral and 2 bilateral) diagnosed with bacterial orbital cellulitis was conducted between November 2005 and May 2019.The mean (± standard deviation) age was 42.1 (± 25.8) years (range: 15 days-86 years). Sinusitis was the most frequent predisposing factor, occurring in 25 patients (37.9%), followed by skin infection in 10 patients (15.2%), and acute dacryocystitis in 9 patients (13.6%). Subperiosteal abscesses were found in 24 eyes and orbital abscesses in 19 eyes. Surgical drainage was performed in 31 eyes. Regarding the abscess volume for surgical drainage, a cut-off of 1514 mm3 showed 71% sensitivity and 80% specificity. There was significant improvement in visual acuity (VA) and decrease in proptosis after treatment (for both, P ≤ .001). Only pre-treatment VA ≤20/200 was a significant predictor for post-treatment VA of 20/50 or worse (adjusted odds ratio: 12.0, P = .003). The presence of a relative afferent pupillary defect was the main predictor of post-treatment VA of 20/200 or worse (adjusted odds ratio: 19.0, P = .003).The most common predisposing factor for orbital cellulitis in this study was sinusitis. VA and proptosis significantly improved after treatment. We found that the abscess volume was strongly predictive of surgical intervention. Pre-treatment poor VA and the presence of relative afferent pupillary defect can predict the worst visual outcome. Hence, early detection of optic nerve dysfunction and prompt treatment could improve the visual prognosis.
Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria; Child; Child, Preschool; Dacryocystitis; Drainage; Humans; Infant; Infant, Newborn; Male; Middle Aged; Optic Nerve Diseases; Orbit; Orbital Cellulitis; Prognosis; Pupil Disorders; Retrospective Studies; Sinusitis; Skin Diseases, Bacterial; Tomography, X-Ray Computed; Treatment Outcome; Visual Acuity; Young Adult
PubMed: 34160383
DOI: 10.1097/MD.0000000000026166 -
Journal of Ophthalmic Inflammation and... Sep 2020Orbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology,...
BACKGROUND
Orbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology, radiologic findings, management and complications of patients with non-medial orbital cellulitis.
METHOD
A retrospective medical record and radiologic file review of patients with infectious orbital cellulitis was performed to detect all patients with non-medial orbital cellulitis who referred to Khalili hospital from 2016 to 2019. Age, sex, origin of infection, size of collection or abscess, medical or surgical management, microbiology, first and final best-corrected visual acuity, duration of admission, and complications was recorded. Patients divided into two groups; medical management and surgical management groups and all of data compared between in this groups.
RESULTS
Of ninety-six patients with infectious orbital cellulitis, 23 cases (14 male, 9 female) were included. Five patients (21.7%) were managed medically and 18 patients (78.3%) were managed surgically. Patients' age range was 5-70 years old. Most common location for non-medial cellulitis was superior space (66.7% in surgical and 40% in medical group; p = 0.511). In 13 cases of surgical group (72.3%) were detected microorganisms. The mean ± SD of collection volume in medical group were 476.5 ± 290.93 mm and 2572.94 ± 1075.75 mm in surgical group (p < 0.001). Ten patients in surgical group had compressive optic neuropathy. The mean ± SD of collection volume was 3204.97 ± 879.88 mm in patient with compressive optic neuropathy and 1280.43 ± 880.68 mm in patient without compressive optic neuropathy (P < 0.001). One case complicated by subdural empyema and another case progressed to necrotizing fasciitis.
CONCLUSION
Non-medial orbital cellulitis is an uncommon but sight-threatening and life-threatening condition. Timely diagnosis and accurate management reduce morbidity and mortality. Combined surgery for patients with superior or supra-temporal and large non-medial abscess is recommended.
PubMed: 32893308
DOI: 10.1186/s12348-020-00213-3 -
Cureus Aug 2022An elderly female presented to the emergency department with a right-sided facial droop and headache for two weeks. Investigations revealed poorly controlled diabetes,...
An elderly female presented to the emergency department with a right-sided facial droop and headache for two weeks. Investigations revealed poorly controlled diabetes, and the patient was found to be in diabetic ketoacidosis. Maxillofacial computed tomography (CT) demonstrated right postseptal cellulitis with concern for acute invasive fungal sinusitis. The patient was taken to the operating room for orbital surgical exploration and antrostomy. Surgical pathology revealed broad hyphae consistent with species, and the patient was diagnosed with mucormycosis. Because the patient was not clinically improving, further imaging was obtained, which showed a large right retroantral phlegmon extending into the cranial fossa and right cavernous sinus, and the patient subsequently underwent surgical debridement. The following postoperative day, the patient was stroke-alerted due to altered mental status and inability to follow commands. She was found to have a small embolic infarct. Due to the poor prognosis of the patient, she was discharged with hospice. Mucormycosis is more commonly found in immunocompromised patients, such as those with uncontrolled diabetes mellitus but very rarely does it involve the cranium. This disease process is very important to recognize early due to high morbidity and mortality rates and devastating outcomes.
PubMed: 36158403
DOI: 10.7759/cureus.28104 -
Cureus Feb 2022Sebaceous cell carcinoma is an uncommonly encountered cutaneous malignancy. Often considered a great masquerader, sebaceous cell carcinoma arises from meibomian glands...
Sebaceous cell carcinoma is an uncommonly encountered cutaneous malignancy. Often considered a great masquerader, sebaceous cell carcinoma arises from meibomian glands and can have a poor prognosis if not diagnosed early. In this case report, we present a patient with sebaceous cell carcinoma who presented to our emergency department with a clinical presentation that was concerning for orbital cellulitis. The patient was initially started on intravenous antibiotics. However, workup, including imaging and laboratory results, pointed toward malignancy as the diagnosis. The patient underwent an incisional biopsy and pathology confirming the diagnosis of sebaceous cell carcinoma. We engaged in further discussion of this peculiar cutaneous masquerader, differential diagnoses, and important considerations.
PubMed: 35350510
DOI: 10.7759/cureus.22288 -
Medical Ultrasonography May 2020Orbital cellulitis is an infrequent but serious complication of sinus infections in children, as was the case of a 7-year-old who presented to the emergency room with...
Orbital cellulitis is an infrequent but serious complication of sinus infections in children, as was the case of a 7-year-old who presented to the emergency room with ultrasound signs of preseptal cellulitis. Despite a well conducted antibiotic treatment a control ultrasound demonstrated associated signs of retro-septal extension. This case brings to light the essential role of ultrasound in suspected cellulitis, as a mean to differentiate between preseptal cellulitis and retroseptal (orbital) cellulitis. In the paediatric population ultrasound should be the first intention exam to diagnose the extension of the illness, and help guide the management and follow-up of the patients.
Topics: Child; Humans; Orbit; Orbital Cellulitis; Ultrasonography
PubMed: 32399531
DOI: 10.11152/mu-2438 -
European Journal of Ophthalmology Jan 2023The coronavirus disease 2019 (COVID-19) is now known to be associated with several ocular manifestations. The literature thoroughly discussed those that affect adults,... (Review)
Review
The coronavirus disease 2019 (COVID-19) is now known to be associated with several ocular manifestations. The literature thoroughly discussed those that affect adults, with a lesser focus in the pediatric age group. We aim to outline the various pediatric ocular manifestations described in the literature. The manifestations may be divided into isolated events attributed to COVID-19 or occurring in the new multisystem inflammatory syndrome in children (MIS-C), a novel entity associated by COVID-19 infection. Ocular manifestations have virtually affected all ages. They manifested in neonates, infants, children, and adolescents. Episcleritis, conjunctivitis, optic neuritis, cranial nerve palsies, retinal vein occlusion, retinal vasculitis, retinal changes, orbital myositis, orbital cellulitis were reported in the literature with this emerging viral illness. Conjunctivitis was the most common ocular manifestation in MIS-C in nearly half of the patients. Other ocular manifestations in MIS-C were anterior uveitis, corneal epitheliopathy, optic neuritis, idiopathic intracranial hypertension, and retinitis. The clinical outcome was favorable, and children regain their visual ability with minimal or no deficits in most of the cases. Further follow-up may be warranted to better understand the long-term effects and visual prognosis.
Topics: Adult; Infant; Infant, Newborn; Adolescent; Humans; Child; COVID-19; Retinitis; Optic Neuritis; Conjunctivitis
PubMed: 35898182
DOI: 10.1177/11206721221116210 -
International Journal of Surgery Case... Jan 2022Orbital cellulitis in children is a potentially fatal emergency and develops rapidly, leading to severe visual loss and life-threatening complications.
INTRODUCTION
Orbital cellulitis in children is a potentially fatal emergency and develops rapidly, leading to severe visual loss and life-threatening complications.
PRESENTATION OF CASE
We report a case of a 16-month-old girl who presented to the emergency department unconscious with a four-day history of a swollen right eyelid. CT scan revealed soft tissue swelling at the superior and inferior palpebral region with bilateral maxillary sinusitis. She had a severe sepsis and received intravenous antibiotics. After her general condition improved, she underwent surgical drainage in conjunction with mini-FESS (functional endoscopic sinus surgery)-the culture of purulent material from which Staphylococcus Aureus was isolated. After a few days, she had hospital-acquired pneumonia, and an abscess in her right eyelid reformed. Immunoglobulin test and lymphocyte subset test was normal. The patient underwent re-surgical drainage and had complete resolution of refractory orbital cellulitis.
DISCUSSION
Severe refractory orbital cellulitis secondary to indolent infection is oftentimes found in immunocompromised patients or in those with underlying ocular diseases; our immunocompetent patient had a seemingly mild case of sinusitis which quickly progressed to severe orbital cellulitis. Oftentimes, broad-spectrum antibiotics are sufficient to treat orbital cellulitis, however, the same cannot be said for our patient, abscess reformed despite appropriate definitive antibiotic therapy in accordance with the culture results.
CONCLUSION
While the main treatment of orbital cellulitis is administration of antibiotics, in certain conditions as found in our patient, patients may not respond well to conservative treatment. Thus, close monitoring is essential, and any sign of progression warrants prompt surgical drainage.
PubMed: 34973629
DOI: 10.1016/j.ijscr.2021.106737 -
Frontiers in Medicine 2022To analyze the clinical characteristics of trauma-dominant orbital cellulitis (OC) and evaluate the risk factors associated with evisceration.
PURPOSE
To analyze the clinical characteristics of trauma-dominant orbital cellulitis (OC) and evaluate the risk factors associated with evisceration.
METHODS
This retrospective study included inpatients diagnosed with orbital cellulitis at the Zhongshan Ophthalmic Center between January 2010 and December 2020. The demographic features, etiology, clinical characteristics, microbiological isolates, and risk factors associated with evisceration were analyzed.
RESULTS
Among 148 consecutive subjects ( = 148, 148 eyes), the mean age was 42.07 ± 20.35 years and 70.27% were male. Penetrating globe injuries were the most common (52.03%). No light perception (NLP) was recorded in 50% of patients on admission. Endophthalmitis was observed in 103 cases (69.59%), intraocular foreign bodies (IOFB) were detected in 43 cases (29.05%), and total corneal melting was observed in 31 cases (20.95%). Sixty patients (40.54%) underwent evisceration. Logistic regression analysis showed that total corneal dissolution [odds ratio (OR) = 83.019, = 0.000], IOFB (OR = 3.402, = 0.016), and NLP (OR = 0.185, = 0.001) were risk factors for evisceration. Microorganism detection showed that and were the leading pathogens.
CONCLUSION
Among hospitalized trauma-dominant OC patients, middle-aged men were the major subjects and penetrating globe injury was the major cause. Significant complications such as complete visual loss and evisceration were unavoidable in many patients with OC in the current study. NLP, IOFB, and total corneal melting were the risk factors for evisceration.
PubMed: 35783626
DOI: 10.3389/fmed.2022.935022