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The British Journal of Ophthalmology Mar 1986Forty-nine cases of orbital cellulitis were reviewed. The average age of patients at presentation was 31 years. The onset of symptoms varied from seven days or less in...
Forty-nine cases of orbital cellulitis were reviewed. The average age of patients at presentation was 31 years. The onset of symptoms varied from seven days or less in 28 patients, one to four weeks in 17 patients, and more than four weeks in four patients. The leucocyte count, available in 33 patients, was greater than 10 X 10(9)/l in only nine. Abnormal sinuses were noted radiographically in 61%. Computed tomography scans, performed on nine patients, revealed non-localised inflammation in three and an orbital mass in six. Cultures, in general, were disappointing. Seventeen surgical procedures were performed on 14 patients. The complications of orbital cellulitis, occurring in five patients, included osteomyelitis of the maxillary bone, strabismus, afferent pupillary defect, chronic draining sinus, and scarred upper eyelid. Usually the treatment of orbital cellulitis requires aggressive parenteral antibiotic therapy and judicious surgical intervention.
Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cellulitis; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Orbital Diseases; Tomography, X-Ray Computed
PubMed: 3954974
DOI: 10.1136/bjo.70.3.174 -
International Medical Case Reports... 2019Proptosis in children with acute-onset accompanied by signs of inflammation is commonly caused by orbital cellulitis, however, the possibility of rhabdomyosarcoma should... (Review)
Review
INTRODUCTION
Proptosis in children with acute-onset accompanied by signs of inflammation is commonly caused by orbital cellulitis, however, the possibility of rhabdomyosarcoma should always be considered by the clinician. This is a case report of a five-year-old boy presenting with an acute-onset of proptosis without a history of trauma and systemic infection. Our clinical differential diagnosis included orbital cellulitis and orbital rhabdomyosarcoma.
PURPOSE
To report a case of orbital cellulitis that clinically and radiologically mimics rhabdomyosarcoma.
CASE PRESENTATION
A five-year-old boy presented with rapid-onset proptosis, periorbital edema, pain and visual loss in the left eye for two weeks without a history of trauma, upper respiratory tract infection, sinusitis or immunosuppression. Our clinical differential diagnosis includes rhabdomyosarcoma and orbital cellulitis. Complete blood count reveals a leukocytosis. Multislice computed tomography (MSCT) scan shows lesions involving the lateral orbit and the retro bulbar space. Antibiotics combination and adjunct anti-inflammatory intravenously shows excellent clinical resolution.
CONCLUSIONS
The study demonstrates difficulty in differentiating acute orbital cellulitis from rhabdomyosarcoma based on clinical findings. In addition, the case highlights that antibiotic combination of cephalosporin and aminoglycosides together with an adjuvant corticosteroid as an anti-inflammatory was effective in the case of acute orbital cellulitis.
PubMed: 31692563
DOI: 10.2147/IMCRJ.S201678 -
Australian Family Physician Jul 2008General practitioners, especially those located in country areas, are commonly the first contact for many patients with an ocular emergency. (Review)
Review
BACKGROUND
General practitioners, especially those located in country areas, are commonly the first contact for many patients with an ocular emergency.
OBJECTIVE
This article aims to provide the GP with a guide to several relatively common ocular emergencies relevant to the general practice setting. It details assessment, initial management and referral planning.
DISCUSSION
Successful patient outcomes in the setting of ocular emergencies depends on correct recognition and assessment as well as appropriate initial management and referral. Assessment involves a concise history, observation, pupil examination; ocular movements should be tested in patients with a suspected orbital wall fracture. Documentation of visual acuity or subjective vision is vital. Important conditions to recognise include penetrating injuries, nonpenetrating injuries, chemical burns, acute angle closure glaucoma, orbital cellulitis and retinal detachment.
Topics: Emergencies; Eye Diseases; Family Practice; Humans; Incidence; New South Wales; Outcome Assessment, Health Care; Referral and Consultation
PubMed: 18592066
DOI: No ID Found -
Case Reports in Ophthalmological... 2021Orbital lymphomas are primarily non-Hodgkin type and can originate from the eyelids, extraocular muscles, soft tissue orbital adnexa, conjunctiva, or lacrimal glands....
BACKGROUND
Orbital lymphomas are primarily non-Hodgkin type and can originate from the eyelids, extraocular muscles, soft tissue orbital adnexa, conjunctiva, or lacrimal glands. Orbital malignancies often represent a diagnostic dilemma for clinicians given their varying and atypical presentations.
OBJECTIVE
To report a case of orbital lymphoma mimicking orbital cellulitis.
CASE
A 66-year-old male patient presented with sudden onset of painful proptosis with visual impairment in the left eye for 15 days. On ocular examination, best-corrected visual acuity was 6/12 in the right eye and 2/60 in the left eye, abaxial proptosis with hypertropia, swollen and erythematous eyelids, restricted extraocular movement in all cardinal position of gaze, conjunctival congestion with chemosis and tortuous vessels, sluggish pupillary reaction, and chorioretinal folds in the inferior quadrants. The case was diagnosed as left eye orbital cellulitis, and the patient was treated with broad-spectrum intravenous antibiotics and oral steroids. No clinically discernible response was noted despite 7 days of antibiotics and steroids. Contrast-enhanced computed tomography (CECT) orbit showed features suggestive of orbital lymphoma involving the ipsilateral maxillary and ethmoid sinuses. ENT consultation with diagnostic nasal endoscopy and biopsy was done. Histopathological reports showed features of non-Hodgkin lymphoma.
CONCLUSION
Orbital malignancies masquerading as orbital cellulitis can pose a diagnostic dilemma. A multidisciplinary approach involving ENT consultation, radiological investigation, and pathological sampling can help achieve a timely diagnosis and appropriate management.
PubMed: 34540302
DOI: 10.1155/2021/8832783 -
Ear, Nose, & Throat Journal Jan 2022Orbital cellulitis is an uncommon condition with risks to sight and life. As a complication of maxillofacial injuries, the literature suggests this is only possible with...
Orbital cellulitis is an uncommon condition with risks to sight and life. As a complication of maxillofacial injuries, the literature suggests this is only possible with fractures or direct inoculation, and there are no reports to the contrary. Here, we make the first report of a possible etiology by which orbital cellulitis developed in a 14-year-old boy even without skin breach or bony fractures; as well as a rare causative pathogen. He presented with facial abscess and progressive orbital cellulitis after blunt facial trauma, requiring functional endoscopic sinus surgery with needle aspiration of facial abscess externally. Cultures showed growth of , and he received further antibiotics with full recovery.The pathophysiology of orbital cellulitis in this patient is attributed to vascular congestion and local pressure from maxillofacial contusion and maxillary hemoantrum, with impaired paranasal sinus ventilation encouraging anaerobic bacterial growth. Further progression led to facial abscess formation and intraorbital spread with orbital cellulitis. The pediatric demographic is injury-prone, and self-reporting of symptoms can be delayed. Hence, increased suspicion of complicated injuries and orbital cellulitis may be required when managing maxillofacial contusions so that prompt treatment can be given.
PubMed: 35023786
DOI: 10.1177/01455613211064002 -
Ocular Oncology and Pathology Feb 2022Uveal melanoma is the most common primary intraocular malignancy in adults, often resulting in painless vision loss. We report a case of necrotic uveal melanoma... (Review)
Review
BACKGROUND
Uveal melanoma is the most common primary intraocular malignancy in adults, often resulting in painless vision loss. We report a case of necrotic uveal melanoma presenting with orbital inflammation mimicking orbital cellulitis and present a comprehensive review of the literature and tabulation of reported cases.
SUMMARY
Our review found 44 published reports of spontaneously necrotic uveal melanoma involving 55 patients. Of these reports, 26 patients (47%) presented with orbital cellulitis. Presenting symptoms of necrotic uveal melanoma with orbital cellulitis included proptosis (82.8%), pain (80.7%), vision loss (61.5%), and restricted extraocular movements (46.2%).
KEY MESSAGES
Uveal melanoma can rarely mimic orbital cellulitis. Autoinfarction and tumor necrosis causes secondary orbital inflammation. Intraocular malignancy must remain in the differential for patients with orbital inflammation and vision loss.
PubMed: 35356597
DOI: 10.1159/000515558 -
Brazilian Journal of Otorhinolaryngology 2022The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis.
OBJECTIVE
The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome.
METHODS
We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group.
RESULTS
Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD=-4.02 [-7.93; -0.12], p-value=0.04, I=96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR=0.78 [0.27; 2.23], p-value=0.64, I=0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group.
CONCLUSION
Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.
Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Cellulitis; Humans; Inflammation; Orbital Cellulitis; Orbital Diseases; Retrospective Studies; Steroids
PubMed: 33722520
DOI: 10.1016/j.bjorl.2021.02.003 -
Saudi Journal of Ophthalmology :... 2021To compare the presentation and outcomes of patients with orbital cellulitis requiring surgical intervention caused by the Group F Streptococcus (GFS) versus other...
PURPOSE
To compare the presentation and outcomes of patients with orbital cellulitis requiring surgical intervention caused by the Group F Streptococcus (GFS) versus other bacteria. We hypothesize that patients with GFS infections have a more severe presentation and worse clinical outcomes compared to infections by other bacteria.
METHODS
After Institutional Review Board approval at a large academic institutional center, 70 patients with culture-positive orbital cellulitis who required surgical intervention were identified. Clinical examinations before and after surgery as well as preoperative imaging with computed tomography and/or magnetic resonance imaging were reviewed. The study measures were preoperative and postoperative vision, motility, involved sinus disease, complications, and total hospital length of stay. Multiple imputation was used for missing data. Characteristics of patients were compared using Chi-square and Wilcoxon rank-sum.
RESULTS
Nineteen patients (27%) had positive cultures for GFS and 51 patients (73%) had positive cultures for other bacterial species. There was no significant difference in visual acuity, motility, or inflammatory markers in patients with GFS compared to other patients. Patients with GFS were noted to have more sinus involvement on presentation compared to patients with other bacterial infections ( = 0.007).
CONCLUSION
GFS associated orbital cellulitis is associated with significantly more sinus involvement, but has similar outcomes as orbital cellulitis from other bacterial species.
PubMed: 34667929
DOI: 10.4103/1319-4534.325780 -
Journal of Ophthalmic Inflammation and... Sep 2021To document the presentation of unilateral combined endophthalmitis and orbital cellulitis in patients with COVID-19 infection and study their prognosis.
PURPOSE
To document the presentation of unilateral combined endophthalmitis and orbital cellulitis in patients with COVID-19 infection and study their prognosis.
PATIENTS AND METHODS
This interventional case series study included 9 patients referred to the Ophthalmology Department, Minia University Hospital with unilateral combined endophthalmitis and orbital cellulitis between April 2020 and March 2021. In addition to the COVID-19 work-up, all patients were subjected to full ophthalmological evaluation and managed according to their ophthalmic and systemic disease.
RESULTS
The patients were 5 females and 4 males. They had clinical, laboratory and imaging findings that confirmed COVID-19 infection. All patients had unilateral endophthalmitis with orbital cellulitis and profound visual loss in the affected eye. Three patients died due to respiratory failure, while 6 patients recovered systemically. The survived patients developed atrophia bulbi in 4 patients and in 2 patients, the globe retained normal size but with complete visual loss.
CONCLUSION
Combined endophthalmitis and orbital cellulitis can be one of the early presentations of patients with COVID-19 infection with poor visual prognosis.
TRIAL REGISTRATION
Clinical registration: clinicaltrials.gov identifier: NCT04456556 .
PubMed: 34523045
DOI: 10.1186/s12348-021-00258-y