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The Annals of Otology, Rhinology, and... Mar 2011Periorbital infection frequently originates from acute rhinosinusitis in children. We tried to find the characteristics of pediatric patients who are likely to develop...
OBJECTIVES
Periorbital infection frequently originates from acute rhinosinusitis in children. We tried to find the characteristics of pediatric patients who are likely to develop subperiosteal orbital abscesses and to need emergency surgery for acute orbital swelling.
METHODS
In an observational retrospective cohort study, we reviewed 64 children less than 18 years of age who visited emergency rooms for periorbital swelling and were hospitalized with a diagnosis of periorbital cellulitis and subperiosteal orbital abscess between 1996 and 2007 at Chang Gung Memorial Hospital. The presence of periorbital abscess was diagnosed radiographically, and all of the patients had concomitant sinusitis that was proved by computed tomographic scan.
RESULTS
The mean age of the patients was 6.95 years, and 42 (65.63%) were male (male-to-female ratio, 1.91). Thirty patients (46.88%) had surgical drainage, and 34 (53.13%) received antibiotic therapy only. The factors associated on bivariate analysis with abscess formation were age of 6 years or less (p = 0.023), proptosis (p = 0.012), fever (p < 0.001), and a white blood cell count of more than 11,100 cells per microliter (p = 0.004). On multivariate analysis, fever and proptosis were independent factors that predicted abscess formation. In patients who underwent surgical drainage, the most frequently cultured microbes were Staphylococcus aureus, Streptococcus viridans, and coagulase-negative staphylococci, and 29% of our patients had polymicrobial pus cultures.
CONCLUSIONS
The most important factor in predicting the failure of antibiotic treatment of sinusitis-related periorbital infections is abscess formation. Patients with fever and proptosis are prone to develop subperiosteal orbital abscesses.
Topics: Abscess; Acute Disease; Adolescent; Age Factors; Anti-Bacterial Agents; Child; Child, Preschool; Drainage; Exophthalmos; Female; Fever; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Infant; Infant, Newborn; Leukocyte Count; Male; Multivariate Analysis; Orbital Cellulitis; Retrospective Studies; Rhinitis; Risk Factors; Sinusitis; Suppuration
PubMed: 21510144
DOI: 10.1177/000348941112000307 -
Ophthalmic Plastic and Reconstructive...Coccidioidomycosis osteomyelitis involving the orbital bones is exceedingly rare and is often misdiagnosed initially as other inflammatory or infectious conditions. No...
Coccidioidomycosis osteomyelitis involving the orbital bones is exceedingly rare and is often misdiagnosed initially as other inflammatory or infectious conditions. No clear guidelines currently exist regarding appropriate management. The authors present an atypical presentation of disseminated coccidioidomycosis in an immunocompetent child with frontal bone superotemporal orbital rim osteomyelitis and associated periorbital abscess, successfully managed with surgical debridement through an upper eyelid crease incision.
Topics: Abscess; Child; Coccidioidomycosis; Eyelids; Humans; Osteomyelitis
PubMed: 33795607
DOI: 10.1097/IOP.0000000000001981 -
JAMA Ophthalmology Jan 2016
Topics: Amoxicillin; Anti-Bacterial Agents; Clindamycin; Combined Modality Therapy; Debridement; Dexamethasone; Drug Implants; Drug Therapy, Combination; Eye Infections, Bacterial; Fasciitis, Necrotizing; Glucocorticoids; Humans; Intravitreal Injections; Male; Middle Aged; Orbital Cellulitis; Streptococcal Infections; Streptococcus pyogenes
PubMed: 26540636
DOI: 10.1001/jamaophthalmol.2015.4351 -
Journal of Neurology, Neurosurgery, and... May 1985A 63-year-old diabetic man presented with sinusitis with orbital and intracranial signs progressing over one week, due to zygomycosis. Despite control of the diabetes,...
A 63-year-old diabetic man presented with sinusitis with orbital and intracranial signs progressing over one week, due to zygomycosis. Despite control of the diabetes, surgical excision of infected tissue and antifungal therapy he died in the fifth week of illness. Pathological study showed extensive fungal infiltration of periorbital structures and mycotic thrombosis of many blood vessels with associated necrosis and infarction of fat and extraocular muscles.
Topics: Diabetes Mellitus, Type 2; Fungi; Humans; Lymphadenitis; Male; Meningitis; Middle Aged; Mycoses; Nose; Nose Diseases; Orbit; Orbital Diseases
PubMed: 4039749
DOI: 10.1136/jnnp.48.5.455 -
Journal of AAPOS : the Official... Apr 2012To report the occurrence of periorbital infections in 3 children treated with the tissue adhesive 2-octyl cyanoacrylate (Dermabond) after traumatic periorbital... (Meta-Analysis)
Meta-Analysis
PURPOSE
To report the occurrence of periorbital infections in 3 children treated with the tissue adhesive 2-octyl cyanoacrylate (Dermabond) after traumatic periorbital laceration.
METHODS
We retrospectively reviewed the records of consecutive patients referred to Vanderbilt Children's Hospital for the treatment of periorbital infections to identify cases associated with the use of Dermabond. The clinical features and outcomes of each case were reviewed. We performed a meta-analysis of published cases to identify any association of tissue adhesive with wound infection rate.
RESULTS
The review identified 3 patients, all of whom were younger than 3 years of age and developed cellulitis within 24 hours of wound closure. Broad-spectrum intravenous antibiotic therapy was started in less than 3 hours in all cases. Cultures were obtained in 2 of the 3 cases; both grew Streptococcus pyogenes. Two cases required surgical intervention, including one with necrotizing fasciitis. In the meta-analysis, the wound infection rate was 1.8% in tissue adhesive closure and 0.3% in standard wound closure (odds ratio 6.0; 95% confidence interval 0.7-50.3, P = 0.06).
CONCLUSIONS
The development of periorbital cellulitis after the closure of periorbital lacerations with Dermabond should alert the physician to the possibility of periorbital infection, including necrotizing fasciitis. The literature review suggests a trend toward an increased infection rate with tissue adhesive closure. We propose that ineffective wound sterilization before tissue adhesive wound closure may be a contributing factor.
Topics: Anti-Bacterial Agents; Child, Preschool; Combined Modality Therapy; Cyanoacrylates; Eye Infections, Bacterial; Eye Injuries, Penetrating; Eyebrows; Fasciitis, Necrotizing; Female; Humans; Infant; Infusions, Intravenous; Lacerations; Male; Ophthalmologic Surgical Procedures; Orbital Cellulitis; Retrospective Studies; Streptococcal Infections; Streptococcus pyogenes; Tissue Adhesives; Wound Infection
PubMed: 22525174
DOI: 10.1016/j.jaapos.2011.11.014 -
[Zhonghua Yan Ke Za Zhi] Chinese... Aug 2017To discuss the etiology, clinical features and treatment principles of the orbital and periorbital abscess. A retrospective case series of 17 cases with orbital and...
To discuss the etiology, clinical features and treatment principles of the orbital and periorbital abscess. A retrospective case series of 17 cases with orbital and periorbital abscess between July 2010 and November 2015 were conducted. All patients(,) clinical data including medical history, etiology, abscess location, paranasal sinus involvement, eye involvement, microbiological test results, imaging features, treatment and prognosis were summarized and analyzed. In all 17 patients, there were 10 males and 7 females with age from 3.0 to 71.0 years (the average age was 33.9 years).Eight patients(,) bacterial cultures of the pus and secretion were positive in all 17 patients. Orbital and periorbital abscess patients could manifest decreased vision, redness and swelling of eyelid, conjunctival congestion and edema, ocular motility disorders, displacement of eyeball, increased orbital pressure, abscess rupture etc. CT showed us the soft tissue mass, accompanied with sinusitis or paranasal sinus mass. MR performed with the long T(1) and T(2) signals. The signals of the abscess cavity were not uniform. For the etiology,11 cases were secondary to sinusitis, including 1 case of diabetes; 2 cases with orbital fractures.One case was secondary to orbital fracture repairment surgery. One case was secondary to the remnant of sequestrum and foreign bodys in the wound after repairment surgery. One case was injured by the hard object. One case was secondary to paranasal sinuses large B-cell lymphoma. One case had diabetic history and the blood sugar was controlled unstablly. For the treatment, 7 cases were treated by the drainage surgery which was performed via the sinus with endoscopic and abscess resection performed via the skin.Two cases were treatment by the abscess resection only.One case was treated by the drainage surgery performed via the sinus with endoscopic only. Six cases were treated by the drainage surgery performed via the skin. One case was only administered intravenous antibiotic. Sixteen cases acquired well prognosis without serious complications except 1 case which occurred central retinal artery and vein occlusion. The orbital and periorbital abscess is mainly a complication of paranasal sinus infection, or secondary to trauma, surgery, tumor, etc; Orbital and periorbital abscess always manifest inflammatory neoplastic clinical features, the key of the diagnosis is to make sure the etiology; Incision and drainage of the abscess is the main treatment method when necessary. We can do the surgery with other departments to avoid the occurrence of serious complications. 588-593.
Topics: Abscess; Adult; Anti-Bacterial Agents; Drainage; Female; Humans; Male; Orbital Diseases; Paranasal Sinuses; Retrospective Studies; Sinusitis
PubMed: 28851199
DOI: 10.3760/cma.j.issn.0412-4081.2017.08.006 -
Ophthalmic Plastic and Reconstructive... 2015To describe the clinical features associated with periorbital necrotizing fasciitis and to correlate these features with clinical outcomes.
PURPOSE
To describe the clinical features associated with periorbital necrotizing fasciitis and to correlate these features with clinical outcomes.
METHODS
The case logs of 3 surgeons were used to identify cases of necrotizing fasciitis. Chart reviews were performed to characterize clinical metrics, and statistical analyses were performed.
RESULTS
Seventeen patients (9 males, 8 females; mean age = 48.1 years, standard deviation = 22.6 years) were identified with periorbital necrotizing fasciitis. Of these patients, 52.9% did not have immunodeficiencies, and 52.9% did not have antecedent trauma or infected facial lesions. One patient died from necrotizing fasciitis. A history of immunosuppression correlated with the requirement for exenteration, but did not correlate visual acuity of worse than 20/40 upon discharge from the hospital. Most of the patients (68.75%) were discharged with visual acuity of better than 20/40 in the affected eye.
CONCLUSIONS
This study represents the largest case series of patients with periorbital necrotizing fasciitis. Most of the patients in this series did not have immunodeficiencies, and the majority were discharged with favorable visual acuities. Nonetheless, a history of immunosuppression correlated with the need for exenteration, but was not statistically linked with worse visual outcomes.
Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Eye Infections, Bacterial; Fasciitis, Necrotizing; Female; Humans; Injections, Intravenous; Male; Middle Aged; Orbital Diseases; Visual Acuity
PubMed: 25675166
DOI: 10.1097/IOP.0000000000000390 -
Klinische Monatsblatter Fur... Nov 2004Infections of the orbit and of the periorbital region are not uncommon. Even today they constitute a serious problem, in spite of modern antibiotic treatment, with a... (Review)
Review
BACKGROUND
Infections of the orbit and of the periorbital region are not uncommon. Even today they constitute a serious problem, in spite of modern antibiotic treatment, with a potential risk of lethal complications. Orbital infections are most prevalent in children and adolescents. The acute orbit has many causes, but the most frequent is an occurrence secondary to acute rhinosinusitis.
PATIENTS AND METHODS
Based on clinical cases, different causes and the present state of diagnosis are presented. The discussion deals with therapeutic strategies depending on the stage according to the current classification of orbital inflammation.
CONCLUSIONS
Orbital and periorbital inflammations represent a demanding challenge for interdisciplinary cooperation between ophthalmologists, ENT specialists and radiologists. In some cases maxillofacial surgeons and neurosurgeons have to be included as well. Accurate diagnosis and treatment may lead to the resolution of the infection and avoid ocular sequel or endocranial complications as well as a fatal outcome.
Topics: Anti-Bacterial Agents; Bacterial Infections; Eye Infections; Humans; Ophthalmologic Surgical Procedures; Orbital Diseases; Practice Guidelines as Topic; Practice Patterns, Physicians'; Rhinitis; Sinusitis; Treatment Outcome
PubMed: 15562360
DOI: 10.1055/s-2004-813682 -
Annals of Emergency Medicine Dec 1996Bacteremic periorbital cellulitis has traditionally been associated with Haemophilus influenzae infection, and the recommended diagnostic evaluation in young children...
STUDY OBJECTIVE
Bacteremic periorbital cellulitis has traditionally been associated with Haemophilus influenzae infection, and the recommended diagnostic evaluation in young children includes blood culture and cerebrospinal fluid (CSF) analysis. The objectives of this study were to examine in pediatric patients with periorbital cellulitis (1) the prevalence of H influenzae bacteremia in the era of vaccination for H influenzae type B (HIB) and (2) the yield of routine CSF analysis.
METHODS
This was a retrospective case series of children aged 2 months to 17 years with a final discharge diagnosis of periorbital cellulitis who were treated from 1986 through 1994 at an urban university referral hospital. The prevalence of bacteremia and meningitis was obtained from chart review.
RESULTS
Forty-nine children were enrolled, of whom 3 were treated as outpatients. The mean age was 36 months (median, 19 months). A blood culture was obtained for 92% of the patients. Five patients (10%; 95% confidence interval, 3% to 22%) had a positive blood culture (four streptococcal species, one H influenzae). The patient with H influenzae bacteremia was treated in 1987 and had not had the HIB vaccine. CSF was analyzed for 41% of the patients, and none had an abnormal cell count or a positive culture. Sinusitis was diagnosed radiographically in 19% of the subjects.
CONCLUSION
Streptococcal organisms are the most common cause of bacteremia associated with periorbital cellulitis in the post-HIB vaccination era. H influenzae bacteremia is now a rare occurrence. Meningitis is uncommon, and lumbar puncture may not be mandatory in well-appearing children. Sinusitis is common and was probably underdiagnosed in our series because most children were not evaluated radiographically. Outpatient management may be indicated in selected children.
Topics: Adolescent; Cellulitis; Cerebrospinal Fluid; Child; Child, Preschool; Female; Haemophilus Infections; Haemophilus Vaccines; Haemophilus influenzae; Humans; Infant; Male; Orbital Diseases; Retrospective Studies; Streptococcal Infections; Streptococcus
PubMed: 8953949
DOI: 10.1016/s0196-0644(96)70083-5 -
Ophthalmic Plastic and Reconstructive... 2016To report 2 immunocompromised patients with sino-orbital necrotizing pseudomonas infections and review the literature. (Review)
Review
PURPOSE
To report 2 immunocompromised patients with sino-orbital necrotizing pseudomonas infections and review the literature.
METHODS
This is a noncomparative, retrospective case series, and review. The clinical data of 2 patients with histopathologic and microbiologic diagnoses of pseudomonas sinus infections causing orbital cellulitis were obtained from medical records. A retrospective literature review was performed on all reported cases of periorbital pseudomonas infections.
RESULTS
One patient with acquired immune deficiency syndrome was noted to have orbital cellulitis with clear visualization of eschar in the middle turbinate on nasal endoscopy. A second patient also had orbital cellulitis with ophthalmoplegia and presence of eschar in the sinus. Both patients had some degree of erosion through the lamina papyracea found on orbital imaging and both had intact vision without optic neuropathy. Pseudomonas infection was confirmed in both cases with permanent histopathology and cultures from conservative sinus debridement.
CONCLUSIONS
Pseudomonas sino-orbital infections must be considered in the differential diagnosis in cases of eschar and orbital wall erosion especially when vision is preserved in immunocompromised individuals. This finding obviates the need for radical debridement including orbital exenteration, which can be indicated in cases of invasive fungal disease.
Topics: Adult; Diagnosis, Differential; Eye Infections, Bacterial; Humans; Immunocompromised Host; Male; Middle Aged; Orbital Diseases; Paranasal Sinus Diseases; Pseudomonas Infections; Pseudomonas aeruginosa; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 26398244
DOI: 10.1097/IOP.0000000000000558