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The Journal of Clinical and Aesthetic... Jan 2016Periorbital hyperpigmentation is a commonly encountered condition. There is very little scientific data available on the clinical profile and pathogenesis of periorbital...
Periorbital hyperpigmentation is a commonly encountered condition. There is very little scientific data available on the clinical profile and pathogenesis of periorbital hyperpigmentation. Periorbital hyperpigmentation is caused by various exogenous and endogenous factors. The causative factors include genetic or heredity, excessive pigmentation, postinflammatory hyperpigmentation secondary to atopic and allergic contact dermatitis, periorbital edema, excessive vascularity, shadowing due to skin laxity and tear trough associated with aging. There are a number of treatment options available for periorbital hyperpigmentation. Among the available alternatives to treat dark circles are topical depigmenting agents, such as hydroquinone, kojic acid, azelaic acid, and topical retinoic acid, and physical therapies, such as chemical peels, surgical corrections, and laser therapy, most of which are tried scientifically for melasma, another common condition of hyperpigmentation that occurs on the face. The aim of treatment should be to identify and treat the primary cause of hyperpigmentation as well as its contributing factors.
PubMed: 26962392
DOI: No ID Found -
Indian Journal of Ophthalmology Jul 2023Infections of orbit and periorbita are frequent, leading to significant morbidity. Orbital cellulitis is more common in children and young adults. At any age, infection... (Review)
Review
Infections of orbit and periorbita are frequent, leading to significant morbidity. Orbital cellulitis is more common in children and young adults. At any age, infection from the neighboring ethmoid sinuses is a likely cause and is thought to result from anatomical characteristics like thin medial wall, lack of lymphatics, orbital foramina, and septic thrombophlebitis of the valveless veins between the two. Other causes are trauma, orbital foreign bodies, preexisting dental infections, dental procedures, maxillofacial surgeries, Open Reduction and Internal Fixation (ORIF), and retinal buckling procedures. The septum is a natural barrier to the passage of microorganisms. Orbital infections are caused by Gram-positive, Gram-negative organisms and anaerobes in adults and in children, usually by Staphylococcus aureus or Streptococcus species. Individuals older than 15 years of age are more likely to harbor polymicrobial infections. Signs include diffuse lid edema with or without erythema, chemosis, proptosis, and ophthalmoplegia. It is an ocular emergency requiring admission, intravenous antibiotics, and sometimes surgical intervention. Computed tomography (CT) and magnetic resonance imaging (MRI) are the main modalities to identify the extent, route of spread from adjacent structures, and poor response to intravenous antibiotics and to confirm the presence of complications. If orbital cellulitis is secondary to sinus infection, drainage of pus and establishment of ventilation to the sinus are imperative. Loss of vision can occur due to orbital abscess, cavernous sinus thrombosis, optic neuritis, central retinal artery occlusion, and exposure keratopathy, and possible systemic sequelae include meningitis, intracranial abscess, osteomyelitis, and death. The article was written by authors after a thorough literature search in the PubMed-indexed journals.
Topics: Child; Young Adult; Humans; Orbital Cellulitis; Abscess; Orbit; Exophthalmos; Anti-Bacterial Agents
PubMed: 37417106
DOI: 10.4103/IJO.IJO_3283_22 -
American Family Physician Jul 2015The swollen red eyelid is a common presentation in primary care. An understanding of the anatomy of the orbital region can guide care. Factors that guide diagnosis and... (Review)
Review
The swollen red eyelid is a common presentation in primary care. An understanding of the anatomy of the orbital region can guide care. Factors that guide diagnosis and urgency of care include acute vs. subacute onset of symptoms, presence or absence of pain, identifiable mass within the eyelid vs. diffuse lid swelling, and identification of vision change or ophthalmoplegia. Superficial skin processes presenting with swollen red eyelid include vesicles of herpes zoster ophthalmicus; erythematous irritation of contact dermatitis; raised, dry plaques of atopic dermatitis; and skin changes of malignancies, such as basal or squamous cell carcinoma. A well-defined mass at the lid margin is often a hordeolum or stye. A mass within the midportion of the lid is commonly a chalazion. Preseptal and orbital cellulitis are important to identify, treat, and differentiate from each other. Orbital cellulitis is more often marked by changes in ability of extraocular movements and vision as opposed to preseptal cellulitis where these characteristics are classically normal. Less commonly, autoimmune processes of the orbit or ocular tumors with mass effect can create an initial impression of a swollen eyelid.
Topics: Diagnosis, Differential; Edema; Eyelid Diseases; Eyelids; Humans
PubMed: 26176369
DOI: No ID Found -
Journal of the Pediatric Infectious... May 2022The epidemiology of orbital cellulitis likely has evolved due to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) and the adoption of pneumococcal... (Review)
Review
BACKGROUND
The epidemiology of orbital cellulitis likely has evolved due to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) and the adoption of pneumococcal conjugate vaccination. In the absence of published guidelines, management is highly variable. We characterized epidemiology and management over an 11-year period.
METHODS
A retrospective cohort study of children 0 to 21 years of age with orbital cellulitis +/- subperiosteal orbital abscess hospitalized at a large quaternary children's hospital from January 2008 to June 2018. We reviewed charts for demographic characteristics, clinical features, management, and outcomes. Using multivariable logistic regression, we evaluated predictors of surgical intervention and assessed whether corticosteroid use or antibiotic duration was related to clinical outcomes.
RESULTS
Among 220 patients, methicillin-susceptible S. aureus was the most common organism (26.3%), with MRSA found in only 5.0%. Rates of vancomycin use fluctuated annually from 40.9% to 84.6%. Surgery was performed in 39.5% of the patients. Corticosteroids, used in 70 patients (32.1%), were unrelated to treatment failure (n = 9), defined as persistent signs and symptoms or initial clinical improvement followed by worsening (P = .137). The median antibiotic duration was 17 days (interquartile range 14-26). After controlling for age, gender, proptosis, eye pain with movement, eyelid swelling, neutrophil count, and corticosteroid use, treatment failure was not significantly associated with receipt of ≥ 3 weeks of antibiotic therapy (8/84, 9.5%) compared with > 2 but < 3 weeks (0/51, 0.0%) or ≤ 2 weeks (1/85, 1.2%) (adjusted odds ratio = 5.83 for ≥ 3 vs ≤2 weeks; 95% confidence interval: 0.58, 59.0).
CONCLUSIONS
Although MRSA was rare, empiric vancomycin use was high. Treatment failure was uncommon in patients who received ≤ 2 weeks of therapy, suggesting that shorter durations are adequate in some patients.
Topics: Abscess; Adrenal Cortex Hormones; Anti-Bacterial Agents; Child; Humans; Infant, Newborn; Methicillin-Resistant Staphylococcus aureus; Orbital Cellulitis; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Vancomycin
PubMed: 35438766
DOI: 10.1093/jpids/piac006 -
Romanian Journal of Ophthalmology 2020This study aimed to determine the most frequent clinical aspects in patients with odontogenic orbital inflammation, the computed tomography (CT) aspect, and the most...
This study aimed to determine the most frequent clinical aspects in patients with odontogenic orbital inflammation, the computed tomography (CT) aspect, and the most appropriate treatment. This is a retrospective case-series study conducted on 3 patients with ages between 16 and 55 years old, in the Ophthalmology and Oro-Maxillo-Facial Clinics of "Sf. Spiridon" Emergency Hospital, Iași, Romania. The following investigations were performed in all selected cases: visual acuity (VA), ocular motility examination, anterior segment examination at slit-lamp, fundus examination, intraoral clinical examination, sinus and orbital involvement on CT scan, pathogens involved. All three patients presented swelling of the genic and periorbital regions, conjunctival chemosis, hyperemia of the conjunctiva, proptosis, pain, decreased vision and extraocular movement restriction. The CT examination identified orbital and periorbital cellulitis and ethmoidal expanded maxillary sinusitis or pansinusitis. Dental extraction, transalveolar drainage and orbital decompression were performed in all three cases. The evolution was favorable with remission of proptosis, edema of the genic and periorbital regions and conjunctival chemosis. Visual acuity remained poor in one case due to total optic nerve atrophy. Our study had a small number of patients, but the data was pertinent to ophthalmologists and maxillofacial surgeons who need to be aware of typical clinical features and the most common etiologies. Late treatment of dental infections can lead to severe ocular manifestations such as orbital cellulitis. Odontogenic orbital inflammation management involves a long-term and multidisciplinary approach. CT = computed tomography, VA = visual acuity, CBCT = cone beam computed tomography, TED = thyroid eye disease, MRI = magnetic resonance imaging, OOC = odontogenic orbital cellulitis, RAPD = relative afferent pupillary defect.
Topics: Adolescent; Adult; Decompression, Surgical; Female; Follow-Up Studies; Humans; Male; Middle Aged; Orbital Cellulitis; Retrospective Studies; Stomatognathic Diseases; Tomography, X-Ray Computed; Young Adult
PubMed: 32685776
DOI: No ID Found -
Rhode Island Medical Journal (2013) Dec 2021Valproate is an antiepileptic medication that can be used to manage behavioral symptoms associated with Alzheimer's dementia. We present a rare case of valproate-induced...
INTRODUCTION
Valproate is an antiepileptic medication that can be used to manage behavioral symptoms associated with Alzheimer's dementia. We present a rare case of valproate-induced periorbital edema.
CASE
A 76-year-old man came to the emergency room with agitation and aggression. He was medically cleared and referred to a psychiatric facility where he was treated with haloperidol. When he developed drug-induced parkinsonism, the haloperidol was stopped, and the patient was started on valproate 250 mg twice daily. The day after valproate administration, the patient developed periorbital edema. After ruling out other causes of periorbital edema, adverse drug reaction was suspected. Valproate was discontinued, and the edema rapidly resolved within five days.
CONCLUSION
Periorbital edema is a rare side effect of valproate. It can occur in patients who are being treated with valproate for behavioral changes in Alzheimer's disease. The edema resolves with discontinuation of the medication.
Topics: Aged; Aggression; Alzheimer Disease; Edema; Humans; Male; Valproic Acid
PubMed: 34846373
DOI: No ID Found -
Ear, Nose, & Throat Journal Sep 2021Pott's puffy tumor is a potential complication of acute frontal sinusitis, characterized by subperiosteal abscess and osteomyelitis of the frontal bone. It can be...
Pott's puffy tumor is a potential complication of acute frontal sinusitis, characterized by subperiosteal abscess and osteomyelitis of the frontal bone. It can be managed with a combination of open and endoscopic sinus surgery and intravenous antibiotic therapy. In the current report, a 15-year-old male presented with a classic case of Pott's puffy tumor which was managed with bilateral ethmoidectomies, frontal sinusotomies, and frontal sinus trephination, resulting in discharge on intravenous antibiotic therapy and subsequent complete resolution of symptoms.
Topics: Abscess; Adolescent; Anti-Bacterial Agents; Edema; Erythema; Ethmoid Sinus; Frontal Bone; Frontal Sinus; Humans; Male; Pott Puffy Tumor; Trephining
PubMed: 34414793
DOI: 10.1177/01455613211039031