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IDCases 2023A healthy 57-year-old man present to outpatient ophthalmological services in southwestern Connecticut with a 16-month history of unilateral periorbital pain,...
A healthy 57-year-old man present to outpatient ophthalmological services in southwestern Connecticut with a 16-month history of unilateral periorbital pain, photophobia, and progressively decreasing visual acuity in his left eye. Prior extensive work-up for uveitis in his home state of Mississippi had yielded no etiology for his symptoms, and empiric therapy with glucocorticoid eye drops had not halted their decline. Fundoscopic examination demonstrated total combined retinal detachment of the left eye. Extensive repeat serological and immunological screening was positive for Toxocara immunoglobulin-G, consistent with a diagnosis of ocular toxocariasis, and the patient completed a course of albendazole with stabilization of symptoms. Despite being endemic to the United States, diagnoses of ocular toxocariasis are extremely uncommon, with the majority of cases occurring in young children. This unusual case of ocular toxocariasis in a healthy adult serves to illustrate that significant, irreversible morbidity can result from lack of both clinician and public awareness of this parasitic infection.
PubMed: 37122593
DOI: 10.1016/j.idcr.2023.e01764 -
Annals of Medicine and Surgery (2012) Apr 2023Cavernous sinus thrombosis (CST) is an unusual condition that can result in high mortality and morbidity rate if not treated immediately.
UNLABELLED
Cavernous sinus thrombosis (CST) is an unusual condition that can result in high mortality and morbidity rate if not treated immediately.
CASE PRESENTATION
An Indonesian male, 47 years old, presented with total right ocular ophthalmoplegia followed by blindness, headache, ptosis, periorbital swelling, and hypoesthesia over the left V1 region. MRI of the brain showed suitable cavernous thickening until the right orbital apex, which in contrast showed enhancement suggestive of right Tolosa-Hunt syndrome. The patient was treated with a high dose of steroids, but the patient's complaints did not improve. The patient underwent digital subtraction angiography and found CST. The optical coherence tomography was found to be central serous chorioretinopathy. He was treated with an antibiotic, anticoagulant, and extraction of the right maxillary molar was performed to remove the source of the infection. After 3 weeks, visual acuity and optical coherence tomography examination were improved.
DISCUSSION
A comprehensive examination, such as digital subtraction angiography, is essential to confirm CST diagnosis for the patient to obtain the right therapy. This report highlighted the value of the prompt diagnosis of CST through neuroimaging and the importance of proper therapy in patient management.
CONCLUSIONS
Early diagnosis, comprehensive examination, and proper treatment of CST will increase good prognosis.
PubMed: 37113961
DOI: 10.1097/MS9.0000000000000131 -
The International Journal of Oral &... 2023To compare different assessment methods for peri-implant inflammation to evaluate potential risk factors and to generate a comprehensive algorithm for clinical staging,...
To compare different assessment methods for peri-implant inflammation to evaluate potential risk factors and to generate a comprehensive algorithm for clinical staging, treatment, and evaluation of success in periorbital implants. In this hospital-based cross-sectional study, 111 periorbital implants in 40 patients with orbital defects after exenteration were clinically analyzed. Skin reaction according to Holgers (SRH), probing depth (PD) , and sulcus fluid flow rate (SFFR), as well as patient-specific data, such as age, sex, smoking and irradiation status, cleaning agent and frequency, defect etiology, implant system, implant location, time span since implantation, and type of retention, were assessed and statistically analyzed via mixed-model calculations. Success was defined as the absence of necessary invasive or antibiotic treatment. A total of 62 implants (55.9%) had been placed in male patients and 49 implants (44.1%) in female patients. There were 18 patients (52 implants, 46.8%) who had received radiotherapy. Mean inflammation levels were low. PD and SFFR were highly correlated, whereby PD increased significantly with time after implantation. SRH ≥ 2 was correlated significantly with higher PD and SFFR values. While 80% of the implants did not require invasive or antibiotic treatment, 45% of the patients presented at least one affected implant. The data gathered allowed for the definition of a staging and treatment algorithm for peri-implantitis in periorbital implants. No patient-specific factors showed a significant impact on peri-implant inflammation. Periorbital implant restorations with magnetic abutments are a safe treatment option for orbital defects. PD and SRH were proven to be valuable quick assessment tools and should be complemented by SFFR, if inconclusive. The established parameters for the staging of peri-implant tissue health and clinical success can serve as a viable tool for reliable and comparable assessment in clinical and scientific settings. Further studies are necessary to assess the suggested treatment algorithm.
Topics: Humans; Male; Female; Dental Implants; Cross-Sectional Studies; Face; Peri-Implantitis; Inflammation
PubMed: 37074268
DOI: 10.11607/jomi.9698 -
Eye (London, England) Nov 2023To evaluate presenting features of patients with orbital solitary fibrous tumours (SFTs), based on histological phenotype.
AIMS
To evaluate presenting features of patients with orbital solitary fibrous tumours (SFTs), based on histological phenotype.
METHODS
A retrospective case-note review was performed for demographics and presenting features for patients with orbital SFTs. The tumours were classified as "Group IA" hypocellular SFT phenotype, "Group IB" haemangiopericytoma phenotype and low mitotic activity, and high-grade "Group II" haemangiopericytoma phenotype with high mitotic activity.
RESULTS
Sixty-four patients (34 female; 53%) presented at a mean age of 42.2 years (median 38; range 19-82), with Group II patients presenting at an older age (mean 53 years). Median symptom duration was 12 months for Groups IA and IB, compared to 4 months for Group II, the commonest symptoms being proptosis (53%), diplopia (41%), periorbital swelling (31%), and altered vision (19%). Mean LogMAR was 0.17 (median 0.0; range -0.2-4), and 14% had ipsilateral optic neuropathy, with no significant difference between the three groups. Non-axial displacement was noted in 69%, a palpable mass in 45%, and reduced eye movements in 59%; choroidal folds and optic disc swelling were recorded in 12% and 9%. SFTs were mostly extraconal (59%), within the superior and superonasal quadrants (44%), with an average estimated tumour volume of 4.9 ml (median 3.6; range 0.31-14.5 ml).
CONCLUSION
SFTs may present with impaired visual function (∼15%), fundal abnormalities (a fifth), globe displacement (two-thirds), and reduced ocular motility (over a half). High-grade tumours tend to present more than a decade later, with a shorter duration of symptoms.
Topics: Humans; Female; Adult; Retrospective Studies; Severe Fever with Thrombocytopenia Syndrome; Hemangiopericytoma; Solitary Fibrous Tumors; Exophthalmos
PubMed: 37061621
DOI: 10.1038/s41433-023-02519-7 -
Journal of Wildlife Diseases Apr 2023Over the last four decades, Barred Owls (Strix varia) have expanded their range to include much of western North America, including California. This expansion is...
Over the last four decades, Barred Owls (Strix varia) have expanded their range to include much of western North America, including California. This expansion is suspected to have contributed to declining populations of a closely related species, the federally threatened Northern Spotted Owl (Strix occidentalis caurina). As a result, understanding potential health threats to Barred Owls has implications for Spotted Owl health and recovery. From 2016 to 2020, 69 Barred Owls were collected to determine the apparent prevalence of periorbital nematode infection, to identify the parasite species present, and to investigate the potential pathologic effects on their hosts. The nematodes were morphologically identified as Oxyspirura and Aprocta spp. On the basis of phylogenetic analyses, they were clearly divergent from published sequences of other species within these genera. Overall, 34 (49%) Barred Owls were infected with periorbital nematodes, with Oxyspirura sp. infections being much more common (94%) than Aprocta sp. (18%). Histopathology revealed varying severity of conjunctivitis in infected owls. Despite the frequency of infection and subsequent inflammation, parasite burden was not associated with reduced body weight in these owls. As a result, the potential health effect of these nematodes is unclear. Further taxonomic characterization is needed to determine potential novelty of these nematodes.
Topics: Animals; Phylogeny; Prevalence; Strigiformes; California; Nematoda
PubMed: 37018547
DOI: 10.7589/JWD-D-21-00186 -
European Journal of Ophthalmology Nov 2023To describe and report the outcomes of doxycycline sclerotherapy in patients with periorbital lymphatic malformations(LMs).
PURPOSE
To describe and report the outcomes of doxycycline sclerotherapy in patients with periorbital lymphatic malformations(LMs).
BASIC PROCEDURES
A retrospective review of consecutive patients diagnosed with periorbital LMs and who received doxycycline sclerotherapy at Hong Kong Eye Hospital and Queen Elizabeth Hospital, Hong Kong between January 2016 and June 2022. Doxycycline was prepared with a concentration of 100 mg diluted in 10 mL water for injection. A 23-gauge needle aiming at the center of the macrocyst was used to aspirate fluid from the lesion; this was then followed by an intralesional injection of 0.5 to 2 ml of doxycycline depending on the size of the cavity.
MAIN FINDINGS
A total of eight patients(six females) were included in this study. All of them received doxycycline sclerotherapy for periorbital LMs(five extraconal, three intraconal). The median age for receiving sclerotherapy was 29 years old. Seven patients had macrocystic LMs, and one had mixed macro- and microcystic LM. Two of the LMs had venous components radiologically. The average number of sclerotherapy treatment in one patient was 1.4 ± 0.7times. Seven of the eight patients had excellent response radiologically or clinically. One patient showed a satisfactory response after three cycles of sclerotherapy. No recurrence was experienced at median follow-up of 14 months. None of the patients experienced visual threatening or systemic complication.
PRINCIPLE CONCLUSIONS
Our preliminary experience with doxycycline sclerotherapy has shown encouraging results for the treatment of macrocystic or mixed-type periorbital LMs, with a favourable safety profile. Further clinical trials with longer follow-ups are warranted on this topic.
PubMed: 36999219
DOI: 10.1177/11206721231163614 -
Journal of Family Medicine and Primary... Nov 2022Aspergillosis is a deep-seated fungal infection caused by the fungus Aspergillus fumigatus. It is commonly seen among farmers, who frequently handle moist hay, which...
Aspergillosis is a deep-seated fungal infection caused by the fungus Aspergillus fumigatus. It is commonly seen among farmers, who frequently handle moist hay, which harbors the spores of the Aspergillus fungus. The infection is acquired by the inhalation of fungal spores and clinically manifests in immunocompromised patients. Such a case of Aspergillosis reported in a 50-year-old male patient with periorbital swelling and multiple sinuses near the lower left eyelid with a complaint of a non-healing socket after dental extraction and treated by coblation turbinoplasty under general anesthesia by endoscopic sinus surgery is described here.
PubMed: 36993094
DOI: 10.4103/jfmpc.jfmpc_1613_21 -
BMJ Case Reports Mar 2023Although several ophthalmic manifestations of sickle cell disease (SCD) are common, orbital bone infarction is rare. Orbital bones have less bone marrow creating an...
Although several ophthalmic manifestations of sickle cell disease (SCD) are common, orbital bone infarction is rare. Orbital bones have less bone marrow creating an unlikely place to develop infarction. However, having a patient with SCD presenting with periorbital swelling should warrant imaging to rule out bone infarction. We present a case of a child with sickle beta-thalassaemia who was misdiagnosed with preseptal cellulitis in the right eye. Later upon review of the subtle signs of bone infarction in imaging, she was discovered to have orbital bone infarction.
Topics: Female; Humans; Child; Cellulitis; beta-Thalassemia; Anemia, Sickle Cell; Tomography, X-Ray Computed; Infarction; Eyelid Diseases; Orbital Cellulitis; Orbital Diseases
PubMed: 36990650
DOI: 10.1136/bcr-2022-252868 -
Indian Journal of Pharmacology 2023Subtenon's block is commonly used to achieve akinesia, analgesia, and anesthesia for ophthalmic surgeries. This case study detailed a rare hypersensitivity report in a...
Subtenon's block is commonly used to achieve akinesia, analgesia, and anesthesia for ophthalmic surgeries. This case study detailed a rare hypersensitivity report in a 65-year-old female who had underwent manual small incision cataract surgery under subtenon's anesthesia (STA) in the left eye. On postoperative day 1, she presented with acute onset proptosis, periorbital edema, conjunctival chemosis, and restriction of extraocular movements. The pupillary reaction and dilated fundus examination were normal. A differential diagnosis of orbital cellulitis, Mucormycosis, and hyaluronidase hypersensitivity (HH) was considered. Since the patient was afebrile, and pupillary reactions, ENT, neurological, and fundus examination were normal, the diagnosis was narrowed down to delayed HH. The patient was managed with a 1 cc IV injection of dexamethasone once a day for 3 days, along with routine postoperative drugs. As per detailed literature review, this is probably a second case report of delayed HH post-STA.
Topics: Female; Humans; Aged; Hyaluronoglucosaminidase; Pandemics; COVID-19; Anesthesia, Local
PubMed: 36960522
DOI: 10.4103/ijp.ijp_995_21 -
Tidsskrift For Den Norske Laegeforening... Mar 2023A young boy presented with acute ethmoiditis and recurrent periorbital swelling. The periorbital swelling was confirmed to be caused by a rare condition.
BACKGROUND
A young boy presented with acute ethmoiditis and recurrent periorbital swelling. The periorbital swelling was confirmed to be caused by a rare condition.
CASE PRESENTATION
Debut symptoms were acute rhinitis, unilateral periorbital swelling, fatigue, and swelling in the temple region, probably caused by an insect bite. Magnetic resonance imaging (MRI) of the sinuses showed bilateral ethmoiditis and unilateral periorbital cellulitis without subperiostal abscess formation, and antibiotics were prescribed. Because of recurrence of the periorbital swelling, an interdisciplinary team started an investigation for a differential diagnosis. The infestation of Hypoderma tarandi was confirmed by recent history of hiking in reindeer habitat, typical clinical presentation and detection of IgG hypodermin C antibodies.
INTERPRETATION
Human myiasis by Hypoderma tarandi is a rare condition in Norway. Typical clinical signs are unaffected general condition, migration of swelling in the forehead, recurrent unilateral periorbital swelling and normal CRP levels. Early-stage diagnosis and treatment will contribute to rapid symptom relief and prevent rare eye and intracranial complications. This case illustrates the importance of investigation for other conditions when the disease course is unexpected. The authors emphasise that knowledge about this disease is important in a variety of medical specialties.
Topics: Male; Animals; Humans; Child; Diptera; Myiasis; Eye Diseases; Edema; Acute Disease; Reindeer
PubMed: 36919299
DOI: 10.4045/tidsskr.22.0434