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Cureus Jan 2024Periorbital emphysema is rare and associated with facial trauma. Its main distinguishing feature is crepitation on palpation of the edema. It resolves spontaneously in a...
Periorbital emphysema is rare and associated with facial trauma. Its main distinguishing feature is crepitation on palpation of the edema. It resolves spontaneously in a few days, but there are cases of orbital compartment syndrome that can lead to loss of vision. Here we present the case of a 55-year-old male who came to the emergency department for bilateral periorbital edema associated with non-steroidal anti-inflammatory drug (NSAID) usage, for pain following a fall from a ladder. He was treated with antihistamines and corticosteroids, for presumed allergic reaction, but without response, and subsequently developed acute onset dyspnea. Chest x-ray revealed a left pneumothorax in the context of chest trauma. Chest CT scan after drain placement shows extensive subcutaneous emphysema. In the differential diagnosis of periorbital edema, in addition to allergic, inflammatory, and systemic causes, the traumatic ones should not be excluded.
PubMed: 38187024
DOI: 10.7759/cureus.51691 -
Cureus Nov 2023Mucormycosis, primarily known to affect the sinuses and brain, severely threatens immunocompromised individuals. Its occurrence in the orbital region is rare and...
Mucormycosis, primarily known to affect the sinuses and brain, severely threatens immunocompromised individuals. Its occurrence in the orbital region is rare and potentially devastating. We report a unique case of a 50-year-old male with longstanding diabetes and hypertension who exhibited isolated orbital mucormycosis confined to the right eye. The patient presented with fever and acute vision loss without classic sinusitis symptoms; earlier mismanagement led to an aggressive relapse. An orbital computed tomography (CT) scan revealed inflammatory changes indicative of an early-stage invasive fungal infection. Comprehensive management involving surgical debridement and antifungal therapy successfully halted intracranial spread and further complications. This case underscores the necessity for high clinical vigilance in diagnosing atypical presentations of mucormycosis in susceptible populations, advocating for a rapid, multidisciplinary approach to ensure optimal outcomes. It also adds to the existing literature on the myriad manifestations of this formidable fungal infection.
PubMed: 38161814
DOI: 10.7759/cureus.49658 -
Asian Journal of Neurosurgery Sep 2023Appropriate fluid management in neurosurgery is critical due to the risk of secondary brain injury. Determination of volume status is challenging with static...
Appropriate fluid management in neurosurgery is critical due to the risk of secondary brain injury. Determination of volume status is challenging with static variables being unreliable. Goal-directed fluid therapy with dynamic variables allows reliable determination of fluid responsiveness and promises better outcomes. We aimed to compare the intraoperative fluid requirement between conventional central venous pressure (CVP)-guided and pulse pressure variance (PPV)-guided fluid management in supratentorial tumor surgeries. This prospective, randomized, double-blind, single-center trial was conducted with 72 adults undergoing supratentorial tumor surgery in a supine position. Patients were divided into two groups of 36 patients each receiving CVP- and PPV-guided fluid therapy. The CVP-guided group received boluses to target CVP greater than 8 mm Hg along with hourly replacement of intraoperative losses and maintenance fluids. The PPV-guided group received boluses to target PPV less than 13% in addition to maintenance fluids. Total intraoperative fluids administered and the incidence of hypotension was recorded along with the brain relaxation score. Postoperatively, serum lactate levels, periorbital and conjunctival edema, as well as postoperative nausea and vomiting were assessed. All statistical analyses were performed with Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States). To compare the means between the two groups (CVP vs. PPV), independent samples -test was used for normal distribution data and Mann-Whitney test for nonnormal distribution data. The chi-square test or Fischer's exact test was used for categorical variables. The CVP group received significantly more intraoperative fluids than the PPV group (4,340 ± 1,010 vs. 3,540 ± 740 mL, < 0.01). Incidence of hypotension was lower in the PPV group (4 [11.1%] vs. 0 [0%], = 0.04). Brain relaxation scores, serum lactate levels, periorbital and conjunctival edema, and incidence of postoperative nausea and vomiting were comparable between the groups. The requirement for intraoperative fluids was less in PPV-guided fluid management with better hemodynamic stability, adequate brain conditions, and no compromise of perfusion.
PubMed: 38152505
DOI: 10.1055/s-0043-1771364 -
Indian Journal of Ophthalmology Jan 2024Atypical mycobacteria or non-tuberculous mycobacteria (NTM) are a group of acid-fast bacteria that are pathogenic to different parts of the eye. The organisms can cause... (Review)
Review
Atypical mycobacteria or non-tuberculous mycobacteria (NTM) are a group of acid-fast bacteria that are pathogenic to different parts of the eye. The organisms can cause a spectrum of ocular infections including keratitis, scleritis, uveitis, endophthalmitis and orbital cellulitis. Trauma, whether surgical or nonsurgical, has the highest correlation with development of this infection. Common surgeries after which these infections have been reported include laser in situ keratomileusis (LASIK) and scleral buckle surgery. The organism is noted to form biofilms with sequestration of the microbe at different inaccessible locations leading to high virulence. Collection of infective ocular material (corneal scraping/necrotic scleral tissue/abscess material/vitreous aspirate, etc.) and laboratory identification of the organism through microbiologic testing are vital for confirming presence of the infection and initiating treatment. In cluster infections, tracing the source of infection in the hospital setting via testing of different in-house samples is equally important to prevent further occurrences. Although the incidence of these infections is low, their presence can cause prolonged disease that may often be resistant to medical therapy alone. In this review, we describe the various types of NTM-ocular infections, their clinical presentation, laboratory diagnosis, management, and outcomes.
Topics: Humans; Nontuberculous Mycobacteria; Mycobacterium Infections, Nontuberculous; Anti-Bacterial Agents; Eye Infections, Bacterial; Keratitis; Eye Infections; Cornea
PubMed: 38131566
DOI: 10.4103/IJO.IJO_560_23 -
Cureus Nov 2023Cavernous sinus thrombosis (CST) is a rare, yet severe condition often linked to infections in the nasal and facial areas. We present a case of a 43-year-old male farmer...
Cavernous sinus thrombosis (CST) is a rare, yet severe condition often linked to infections in the nasal and facial areas. We present a case of a 43-year-old male farmer with diabetes who initially showed ear abscess symptoms that progressed to vision loss and CST-like symptoms. Self-treatment and an unidentified medication regimen may have worsened his condition. Advanced diagnostic evaluations, particularly magnetic resonance imaging with magnetic resonance venography, confirmed CST, likely originating from the ear infection spreading to the eyes, causing bilateral orbital cellulitis. Treatment with antibiotics, anticoagulants, and supportive therapy stabilized the patient's condition. This case emphasizes the importance of early detection and intervention in CST, especially in atypical presentations, and the need for comprehensive diagnostic and therapeutic approaches.
PubMed: 38106764
DOI: 10.7759/cureus.48922 -
Ugeskrift For Laeger Dec 2023In this case report, two patients were initially presented with orbital symptoms due to undiagnosed sinonasal disease. An eight-year-old girl was suspected of preseptal...
In this case report, two patients were initially presented with orbital symptoms due to undiagnosed sinonasal disease. An eight-year-old girl was suspected of preseptal cellulitis due to swelling and redness around the right eye for a month. MRI of the orbit showed a change in the orbit suspected to be a tumour. Regression in symptoms was seen after three months and a mucocele was suspected. The other patient was a 57-year-old woman suspected of left-side acute dacryocystitis with a palpable mass above the medial canthus for a month. MRI was performed due to atypical presentation and showed tumour changes originating from the ethmoid sinus.
Topics: Female; Humans; Middle Aged; Child; Orbit; Head; Neoplasms
PubMed: 38105733
DOI: No ID Found -
Ocular Oncology and Pathology Dec 2023The aim of the study was to compare complication rates and hospital costs of myoconjunctival versus conventional enucleation techniques in retinoblastoma.
INTRODUCTION
The aim of the study was to compare complication rates and hospital costs of myoconjunctival versus conventional enucleation techniques in retinoblastoma.
METHODS
This retrospective cohort and cost analysis reviewed patients with retinoblastoma treated by primary or secondary enucleation between 2003 and 2021 and a minimum 6-month follow-up. Cases were reviewed for three postsurgical complications: chronic conjunctivitis, implant exposure/extrusion, and cellulitis. Cases were excluded if surgery was performed elsewhere or documentation was incomplete. Treatment costs were estimated based on two sample cases billed in 2021 that manifested the studied complications and represented each of the two surgical techniques. Univariate and multivariate analyses were applied to compare complication rates and treatment costs.
RESULTS
Included were 180 eyes (179 patients); 239 eyes (227 patients) were excluded. Patients had median age of 18.9 (0-104.4) months at diagnosis, the majority were male (94, 52%), with unilateral (115, 64%) group D or E (163, 91%) eyes. Enucleation was performed by conventional techniques in 107 eyes (59%) and by myoconjunctival approach in 73 (41%). Orbital complications occurred in 61 eyes (34%) during a median follow-up of 7.9 (0.5-33.7) years, more frequently in the conventional technique group ( = 0.014). The myoconjunctival technique had significantly lower costs for implant price ( < 0.001) and estimated treatment cost, including complication management ( < 0.001).
CONCLUSION
Enucleation by myoconjunctival technique showed significantly less complication burden and treatment cost, indicating advantages over conventional approaches. Study limitations include the retrospective nature, confounders' complexity, and follow-up time variations.
PubMed: 38089181
DOI: 10.1159/000531871 -
Beyoglu Eye Journal 2023Idiopathic orbital inflammatory disease is a benign, non-infectious, and non-neoplastic space-occupying orbital and peri-orbital inflammation with no identifiable local...
Idiopathic orbital inflammatory disease is a benign, non-infectious, and non-neoplastic space-occupying orbital and peri-orbital inflammation with no identifiable local or systemic causes. Patients usually present with eyelid and periorbital erythema and edema, proptosis, and decreased eye movements. In this report, a case of large serous retinal detachment accompanying a unilateral idiopathic orbital inflammatory disease attack is discussed. It demonstrates that very extensive and highly serous retinal detachment may accompany idiopathic orbital inflammatory disease attacks. Dramatic improvement in clinical findings and imaging can be observed with high-dose steroid treatment in a short time.
PubMed: 38089077
DOI: 10.14744/bej.2023.65265 -
Cureus Nov 2023The authors present the case of a 39-year-old male who presented to the hospital with worsening eye pain, swelling, and blurred vision of the left eye. His symptoms grew...
The authors present the case of a 39-year-old male who presented to the hospital with worsening eye pain, swelling, and blurred vision of the left eye. His symptoms grew worse despite initial over-the-counter medication and a trip to the urgent care center. A physical exam was concerning for a possible orbital cellulitis given the appearance of the eye and the amount of discomfort, as well as their immunocompromised status, necessitating imaging and workup to confirm the diagnosis. The patient was ultimately diagnosed with periorbital cellulitis and bacterial conjunctivitis, and he received intravenous antibiotics for treatment. This case underscores the importance of a comprehensive diagnostic approach to managing ocular infections.
PubMed: 38074053
DOI: 10.7759/cureus.48439 -
Respiratory Medicine Case Reports 2023Invasive fungal rhinosinusitis is a rare disease with a high morbidity and mortality rate. Lately, COVID-19 has been associated with an increased incidence of this...
Invasive fungal rhinosinusitis is a rare disease with a high morbidity and mortality rate. Lately, COVID-19 has been associated with an increased incidence of this disease. We present the first case of COVID-19-associated acute invasive fungal rhinosinusitis found in Indonesia. The risk factors for the disease include corticosteroid use and antibiotic use. The case was complicated with left orbital cellulitis and cerebral abscess. Difficulty of management in Indonesia during the COVID-19 pandemic includes hesitancy of the patient to seek medical care and the availability of surgical team for COVID-19-positive patients. Monitoring of corticosteroid and antibiotic use must be emphasized during the pandemic. Awareness of the disease needs to be increased in Indonesia.
PubMed: 38046461
DOI: 10.1016/j.rmcr.2023.101916