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International Journal of Pediatric... Oct 1987Periorbital cellulitis is a common complication of sinusitis in children. At some hospitals lumbar puncture is routinely done as part of the complete evaluation of...
Periorbital cellulitis is a common complication of sinusitis in children. At some hospitals lumbar puncture is routinely done as part of the complete evaluation of children admitted with periorbital cellulitis. Presumably, the lumbar puncture is done to rule out meningitis which could be the result of extension of infection from the orbit to the central nervous system (CNS). However, the degree to which periorbital cellulitis is associated with CNS complication is not known and the necessity for routine lumbar puncture is questioned. Therefore, records of 102 children admitted to the Children's Hospital National Medical Center from 1975 to 1982 with the diagnosis of periorbital cellulitis were reviewed. There were two cases of meningitis and one case of bilateral subdural effusions. Review of the literature and the findings in this study suggests that routine lumbar puncture in seemingly uncomplicated cases of periorbital cellulitis probably is not indicated in children 6 months of age or older.
Topics: Adolescent; Adult; Cellulitis; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Orbit; Orbital Diseases; Retrospective Studies; Sinusitis; Spinal Puncture
PubMed: 3679683
DOI: 10.1016/0165-5876(87)90108-x -
Head & Neck Surgery 1987Periorbital cellulitis is a commonly occurring infectious process limited to the eyelids in the preseptal region. It occurs with greater frequency in the pediatric age... (Review)
Review
Periorbital cellulitis is a commonly occurring infectious process limited to the eyelids in the preseptal region. It occurs with greater frequency in the pediatric age group. It is important to distinguish this disease from orbital cellulitis, a potentially lethal infectious process involving the contents of the orbit. A retrospective study of clinical and laboratory data from 137 cases with orbital and periorbital cellulitis was performed. Periorbital cellulitis was documented in 98 cases (71%) in contrast to orbital cellulitis, which was noted in 39 (28%) patients. Sinusitis was the most frequently encountered predisposing factor for the development of periorbital cellulitis occurring in 29 patients. All patients with a diagnosis of periorbital cellulitis were hospitalized and received antibiotics, the majority (95%) receiving intravenous therapy. Hemophilus influenzae was the most frequently isolated pathogenic organism. It was necessary to operate on eight patients. Six patients underwent incision and drainage of an eyelid or periorbital abscess. A distinction between periorbital and orbital cellulitis is clarified. The separation of these entities on the basis of physical examination and radiographic studies is stressed.
Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cellulitis; Child; Child, Preschool; Diagnosis, Differential; Eyelid Diseases; Female; Haemophilus Infections; Humans; Infant; Infant, Newborn; Male; Middle Aged; Orbital Diseases; Retrospective Studies
PubMed: 3312114
DOI: 10.1002/hed.2890090406 -
Scottish Medical Journal Aug 2018Head and neck necrotising soft-tissue infection is exceptionally uncommon in the paediatric population. necrotising soft-tissue infection is severe and often...
Head and neck necrotising soft-tissue infection is exceptionally uncommon in the paediatric population. necrotising soft-tissue infection is severe and often life-threatening. Rapid spread of infection and systemic illness make necrotising soft-tissue infection a challenge for the medical and surgical teams. Early identification and surgical intervention are essential for a favourable patient outcome. This report details the case of periorbital necrotising soft-tissue infection in a 12-year-old male patient following an uncomplicated facial laceration. Prompt surgical debridement with planned return visits to theatre and guided empirical antibiotic therapy ensured that a satisfactory patient outcome was achieved. The failure of current necrotising soft-tissue infection diagnostic scoring tools to be positive in this case may suggest that these tools require refinement and validation.
Topics: Anti-Bacterial Agents; Child; Debridement; Eye Infections, Bacterial; Fasciitis, Necrotizing; Humans; Lacerations; Male; Plastic Surgery Procedures; Soft Tissue Infections; Surgical Flaps; Treatment Outcome
PubMed: 29806539
DOI: 10.1177/0036933018776830 -
BMJ Case Reports Dec 2020A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging....
A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging. Blood cultures were positive for growth of group A (GAS). Broad spectrum antimicrobials were initiated with the inclusion of the antitoxin agent clindamycin. Necrosis of periorbital tissue was noted and surgical consultation was obtained. Débridement of both eyelids with skin grafting was performed. GAS was isolated from wound cultures and also observed on periorbital tissue microscopy. The final diagnosis was bilateral periorbital necrotising fasciitis (PONF) associated with invasive GAS infection. The patient had a prolonged intensive care unit course with input from multiple specialist teams. This case demonstrates the importance of early recognition and treatment of PONF, the profound systemic morbidity caused by these infections, and illustrates successful multidisciplinary teamwork.
Topics: Anti-Bacterial Agents; Debridement; Drug Therapy, Combination; Eyelids; Fasciitis, Necrotizing; Female; Humans; Middle Aged; Severity of Illness Index; Shock, Septic; Skin Transplantation; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome
PubMed: 33370943
DOI: 10.1136/bcr-2020-236800 -
Acta Ophthalmologica Nov 2013Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the... (Review)
Review
Necrotizing fasciitis (NF) is a severe infection characterized by rapidly progressing necrotizing infection of the superficial fascia with secondary necrosis of the overlying skin. Periorbital NF is uncommon because of the excellent blood supply to that area; nevertheless, it can sometimes result in death. The aim of this study is to present a systematic review and analyse the factors associated with death. We carried out a systematic literature review of all cases of periorbital NF published in the English language over the past 20 years and present the predisposing conditions, triggering factors, organisms causing NF, presence or absence of toxic shock and the prognosis. The significance of various risk factors leading to death was analysed. We traced a total of 94 patients with periorbital NF from 61 reports. There were no triggering incidents in 25 cases (26.6%). In 48 cases (51.1%), the organism responsible for NF was Group A beta haemolytic Streptococcus. Toxic shock occurred in 29 (30.9%) cases, and loss of vision in 13 (13.8%). Surgical debridement was carried out in 80 (85.1%) cases. There were eight cases (8.5%) of death. This seems to be less than previously reported figures. Toxic shock syndrome (p < 0.001), type 1 infections (p = 0.018), facial involvement (p = 0.032) and blindness because of periorbital NF (p = 0.035) were significantly associated with mortality. Mortality caused by NF arising from the periorbital area seems to be on the decline. However, it is important to recognize it early and institute treatment to avoid toxic shock that leads to death. Type 1 infections, although rare in periorbital area, are not associated with immunocompromised status and nevertheless carry a significant risk of mortality. Major morbidity is loss of vision followed by soft-tissue defects affecting function and cosmesis.
Topics: Eye Infections, Bacterial; Fasciitis, Necrotizing; Humans; Necrosis; Orbital Diseases; Risk Factors; Skin; Streptococcal Infections
PubMed: 22520175
DOI: 10.1111/j.1755-3768.2012.02420.x -
Current Opinion in Ophthalmology Sep 2012Periorbital edema is a common problem that deserves scrutiny. Although a variety of healthcare providers may see this clinical entity, ophthalmologists are often... (Review)
Review
PURPOSE OF REVIEW
Periorbital edema is a common problem that deserves scrutiny. Although a variety of healthcare providers may see this clinical entity, ophthalmologists are often consulted along the way toward diagnosis. It can challenge even the most astute clinicians. A diagnosis may reveal merely a bothersome issue or potentially a sight-threatening or life-threatening problem.
RECENT FINDINGS
Comprehensive reviews on this topic are scarce. Textbooks are brief. There are, however, many studies in the scientific literature of notable cases of periorbital edema. The causes generally fall into the categories of infectious, inflammatory or tumors, medication related, and postsurgical or trauma.
SUMMARY
This article synthesizes the current literature on the topic with a case series from our institution. It aims to provide a thorough resource for all practitioners to make the prospect of triaging, diagnosing, and treating periorbital edema less daunting.
Topics: Diagnosis, Differential; Edema; Eye Infections; Eyelid Diseases; Graves Ophthalmopathy; Humans; Inflammation; Orbital Diseases
PubMed: 22729182
DOI: 10.1097/ICU.0b013e3283560ace -
Ophthalmic Plastic and Reconstructive... Dec 1994A differential diagnosis of inflammatory periocular soft tissue masses includes sarcoidosis, ruptured dermoid cyst, infectious abscess, metastatic neoplastic disease,...
A differential diagnosis of inflammatory periocular soft tissue masses includes sarcoidosis, ruptured dermoid cyst, infectious abscess, metastatic neoplastic disease, and idiopathic pseudotumor. The authors present the case of a 42-year-old woman with a periocular inflammatory mass caused by dirofilaria of a nematode classification as Dirofilaria tenuis. The extraction of the worm was curative and the patient has been symptom-free for the ensuing 12 months. This zoonotic infection, spread by mosquito vectors from animal hosts to humans, is rarely encountered in the United States as a cause of periorbital inflammation. A history of migratory swelling and residence in, or travel to, endemic areas (the southeastern United States) should suggest the possibility of Dirofilaria infection.
Topics: Adult; Animals; Dirofilaria; Dirofilariasis; Eye Infections, Parasitic; Female; Humans; Orbital Diseases
PubMed: 7865454
DOI: 10.1097/00002341-199412000-00015 -
Current Opinion in Ophthalmology Oct 2001Infections of the orbit and periorbital tissues are not uncommon. Trauma, skin infections, and sinusitis are frequently the underlying cause. Studies have shown changes... (Review)
Review
Infections of the orbit and periorbital tissues are not uncommon. Trauma, skin infections, and sinusitis are frequently the underlying cause. Studies have shown changes in epidemiology and pathogens in the last decade. Although classical manifestations are usually present, atypical cases without specific signs and symptoms may confound the diagnosis. A high index of suspicion, aided by ultrasonography, computed tomography, and magnetic resonance imaging, is frequently required for an accurate diagnosis. Prompt diagnosis and treatment may lead to resolution of the infection, thus avoiding ocular sequelae. Orbital infections may spread into the globe, causing endophthalmitis. Some patients may even need an enucleation or evisceration. New materials and techniques may improve the final result of an anophthalmic socket.
Topics: Abscess; Cavernous Sinus Thrombosis; Cellulitis; Endophthalmitis; Eye Infections; Humans; Orbital Diseases
PubMed: 11588494
DOI: 10.1097/00055735-200110000-00002 -
International Forum of Allergy &... Jun 2020Periorbital cellulitis is a potential sight-threatening complication of sinusitis. The majority of patients improve with medical management. Previous studies have... (Clinical Trial)
Clinical Trial
BACKGROUND
Periorbital cellulitis is a potential sight-threatening complication of sinusitis. The majority of patients improve with medical management. Previous studies have suggested significant variations in practice and lack of evidence regarding the optimal management of this condition.
METHODS
A prospective study was conducted over a 12-month period at 8 centers in the United Kingdom assessing the management of patients requiring inpatient treatment for periorbital cellulitis secondary to sinonasal infections.
RESULTS
A total of 143 patients were recruited, of whom 40 were excluded. Of the remaining 103 patients, 5 (4.9%) were diagnosed with neurosurgical complications. This resulted in 98 patients admitted with periorbital cellulitis secondary to an upper respiratory tract infection/sinusitis. A total of 72 were children, of whom 12 (16.7%) required surgical intervention; and of 26 adults, 5 (19.2%) required surgery: the most common antimicrobial regimes administered were intravenous ceftriaxone (with or without metronidazole), and co-amoxiclav. The use of both ceftriaxone and metronidazole from admission was associated with the shortest duration of inpatient stay (3.8 days) in comparison to ceftriaxone alone (5.8 days) or co-amoxiclav (4.5 days) and a reduction in number of patients requiring surgical intervention. There was also an association between the early use of intranasal decongestants and steroids and reduction in requirement for surgical intervention.
CONCLUSION
For a condition where swab and blood cultures are often negative, this study supports the use of ceftriaxone in combination with metronidazole. The administration of intranasal decongestants and corticosteroids correlated with a smaller percentage of those progressing to surgery in those with and without periorbital abscesses.
Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cellulitis; Child; Drug Therapy, Combination; Humans; Length of Stay; Metronidazole; Nasal Decongestants; Practice Patterns, Physicians'; Prospective Studies; Respiratory Tract Infections; Sinusitis; Steroids; United Kingdom
PubMed: 32282127
DOI: 10.1002/alr.22535 -
Orbit (Amsterdam, Netherlands) Mar 2007An observational case series of seven cases of periorbital tuberculosis, a rare tubercular presentation occurring in patients with and without systemic disease, is...
An observational case series of seven cases of periorbital tuberculosis, a rare tubercular presentation occurring in patients with and without systemic disease, is presented. Non-healing sinus and osteomyelitis of periorbital flat bones was observed. All cases had a positive Monteaux test and PCR. AFB cultures of the sinus discharge were negative. The response to triple-drug therapy was dramatic. Follow-up at the end of one year showed clinical recovery. The authors stress the need for a high index of suspicion in cases of non-healing lesions and atypical inflammatory presentation in the periorbital region.
Topics: Adolescent; Antitubercular Agents; Child; Drug Therapy, Combination; Female; Humans; Male; Orbital Diseases; Tuberculosis, Ocular
PubMed: 17510870
DOI: 10.1080/01676830600671482