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American Family Physician Dec 2007The differential diagnosis of eyelid erythema and edema is broad, ranging from benign, self-limiting dermatoses to malignant tumors and vision-threatening infections. A... (Review)
Review
The differential diagnosis of eyelid erythema and edema is broad, ranging from benign, self-limiting dermatoses to malignant tumors and vision-threatening infections. A definitive diagnosis usually can be made on physical examination of the eyelid and a careful evaluation of symptoms and exposures. The finding of a swollen red eyelid often signals cellulitis. Orbital cellulitis is a severe infection presenting with proptosis and ophthalmoplegia; it requires hospitalization and intravenous antibiotics to prevent vision loss. Less serious conditions, such as contact dermatitis, atopic dermatitis, and blepharitis, are more common causes of eyelid erythema and edema. These less serious conditions can often be managed with topical corticosteroids and proper eyelid hygiene. They are differentiated on the basis of such clinical clues as time course, presence or absence of irritative symptoms, scaling, and other skin findings. Discrete lid lesions are also important diagnostic indicators. The finding of vesicles, erosions, or crusting may signal a herpes infection. Benign, self-limited eyelid nodules such as hordeola and chalazia often respond to warm compresses, whereas malignancies require surgical excision.
Topics: Blepharitis; Diagnosis, Differential; Edema; Eyelids; Humans
PubMed: 18217520
DOI: No ID Found -
Indian Journal of Ophthalmology Apr 2022Dirofilariasis is an emerging zoonosis in India. Most of the cases from India have been reported from the states of Kerala, coastal Karnataka and Maharashtra, and a few...
BACKGROUND
Dirofilariasis is an emerging zoonosis in India. Most of the cases from India have been reported from the states of Kerala, coastal Karnataka and Maharashtra, and a few from the North India, Orissa and Assam. Dogs, cats, foxes and other wild animals are definitive hosts for dirofilaria. Human ocular parasitosis is prevalent in geographical areas where environmental factors and poor sanitary conditions favor parasitism between humans and animals. However, in recent years, migrating population have facilitated the spread of certain parasitic diseases from endemic to non-endemic areas. We report a case of subconjunctival dirofilariasis in a 91-year-old man, who presented with features of orbital cellulitis. An intact live worm, measuring 13.5 cm, was extracted from the subconjunctival space, following which there was prompt resolution of symptoms.
PURPOSE
Given the increase in the frequency of dirofilariasis in humans in recent years, medical practitioners should bear in mind the possibility of ocular dirofilariasis when a patient presents with an ocular or orbital inflammatory lesion.
SYNOPSIS
This video illustrates various presentations of ocular dirofilaria and surgical extraction of a live worm from the subconjunctival space.
HIGHLIGHTS
Lifecycle and human ocular manifestations of dirofilaria ared elucidated. Rare presentation of subconjunctival dirofilariasis as orbital cellulitis and its resolution following removal of the live worm has been demonstrated.
VIDEO LINK
https://youtu.be/Nj8unz0S85M.
Topics: Aged, 80 and over; Animals; Conjunctiva; Dirofilaria; Dirofilariasis; Humans; India; Male; Orbital Cellulitis
PubMed: 35326084
DOI: 10.4103/ijo.IJO_630_22 -
Case Reports in Ophthalmology 2022A 72-year-old male patient was referred to our outpatient clinic with a painful left eye protrusion accompanied by marked conjunctival chemosis and external...
A 72-year-old male patient was referred to our outpatient clinic with a painful left eye protrusion accompanied by marked conjunctival chemosis and external ophthalmoplegia being progressed despite topical and oral antibiotic therapy. He developed ocular symptoms 9 days after receiving his second SARS-CoV-2 vaccine (VeroCell). Of note, in previous history, 2 weeks after the first dose of the COVID-19 vaccine, he also developed a life-threatening laryngeal oedema treated at an emergency care unit. MRI of the orbit excluded pansinusitis as possible origin of the orbital cellulitis, and repeated COVID-19 antigen and antibody PCR tests were negative during his hospitalization. On the next day after his admittance, parenteral dexamethasone 250 mg/die treatment was commenced resulting in a quick and complete resolution of the symptoms. Due to the facts regarding this case, such as the temporal coincidence and the lack of respective comorbidity, there might be a causative relationship between the vaccination and the presented orbital cellulitis. To the best of our knowledge, this is the first report on orbital cellulitis as a possible ocular adverse event following COVID-19 vaccination.
PubMed: 35611007
DOI: 10.1159/000523803 -
Cureus Aug 2020Periorbital ecchymosis and edema are common after septorhinoplasty surgery. This study aimed to compare internal and external lateral nasal osteotomies performed in...
OBJECTIVE
Periorbital ecchymosis and edema are common after septorhinoplasty surgery. This study aimed to compare internal and external lateral nasal osteotomies performed in septorhinoplasty in terms of postoperative ecchymosis and edema.
METHODS
Patients who underwent septorhinoplasty between January 2020 and July 2020 in our clinic were included in the study. In all patients, right lateral nasal osteotomies were performed endonasally and left lateral nasal osteotomies externally. The postoperative 1st, 7th, and 14th day ecchymosis and edema scores of all patients were calculated separately for the two groups and compared.
RESULTS
A total of 60 patients (29 females, 31 males) were included in the study. The mean age of the patients was 33.88 ± 10.30 years. No significant difference was observed between the two groups in terms of the postoperative periorbital ecchymosis scores on the first day and the first and second weeks (0.314, 0.344, and 0.468, respectively). There was also no significant difference between the two groups in terms of the postoperative periorbital edema scores on the first day and at the first and second weeks (0.272, 0.359, and 0.513, respectively).
CONCLUSION
The results obtained from this study showed no significant difference in the periorbital ecchymosis and edema scores between the patients who had undergone septorhinoplasty with internal or external lateral osteotomies. Further multicenter studies are recommended to verify the findings of this study with a larger sample size.
PubMed: 32923211
DOI: 10.7759/cureus.9609 -
Ocular Oncology and Pathology Dec 2020A masquerade syndrome is an atypical presentation of a neoplastic process that mimics an inflammatory condition. In this paper, we focus on orbital pseudocellulitis.
INTRODUCTION
A masquerade syndrome is an atypical presentation of a neoplastic process that mimics an inflammatory condition. In this paper, we focus on orbital pseudocellulitis.
CASE SERIES
Our case series includes 5 retinoblastoma patients with orbital pseudocellulitis at presentation. In 3 patients the disease was bilateral, in 1 trilateral, and in 1 unilateral. The eyes with pseudocellulitis were enucleated, while the fellow eyes were treated conservatively, when affected. Four patients responded well to the therapy and showed remission of the tumor. The patient with trilateral retinoblastoma did not respond to therapy and died of disease.
DISCUSSION
Differential diagnosis with infectious orbital cellulitis is extremely important. Patients with orbital cellulitis present with fever, sinusitis, leukocytosis, and raised inflammatory markers, while ophthalmoscopic examination is negative and imaging studies show sinus involvement. On the contrary, patients with retinoblastoma do not show systemic inflammation, while ophthalmoscopic examination reveals leukocoria, buphthalmos, and an intraocular tumor mass associated with retinal detachment. Magnetic resonance imaging shows intralesional calcifications and soft tissue edema without sinus involvement. Histology confirms the diagnosis.
CONCLUSIONS
Medical history, physical examination, and imaging studies are crucial in the diagnosis of retinoblastoma-associated orbital pseudocellulitis. Retinoblastoma should be excluded in all patients with signs of pre-septal orbital cellulitis through fundoscopy and/or imaging studies.
PubMed: 33447593
DOI: 10.1159/000509810 -
World Journal of Radiology Apr 2014Orbital inflammatory disease (OID) represents a collection of inflammatory conditions affecting the orbit. OID is a diagnosis of exclusion, with the differential... (Review)
Review
Orbital inflammatory disease (OID) represents a collection of inflammatory conditions affecting the orbit. OID is a diagnosis of exclusion, with the differential diagnosis including infection, systemic inflammatory conditions, and neoplasms, among other conditions. Inflammatory conditions in OID include dacryoadenitis, myositis, cellulitis, optic perineuritis, periscleritis, orbital apicitis, and a focal mass. Sclerosing orbital inflammation is a rare condition with a chronic, indolent course involving dense fibrosis and lymphocytic infiltrate. Previously thought to be along the spectrum of OID, it is now considered a distinct pathologic entity. Imaging plays an important role in elucidating any underlying etiology behind orbital inflammation and is critical for ruling out other conditions prior to a definitive diagnosis of OID. In this review, we will explore the common sites of involvement by OID and discuss differential diagnosis by site and key imaging findings for each condition.
PubMed: 24778772
DOI: 10.4329/wjr.v6.i4.106 -
Clinical Ophthalmology (Auckland, N.Z.) 2021COVID-19 infection is a respiratory disease but it can have ophthalmological manifestations as well. This study aimed to investigate the ophthalmological implications of...
BACKGROUND AND AIM
COVID-19 infection is a respiratory disease but it can have ophthalmological manifestations as well. This study aimed to investigate the ophthalmological implications of COVID-19 either during the course of the disease or after recovery.
METHODS
A retrospective study included the records of 425 COVID-19 patients, proved by positive PCR swabs. The records were collected from three isolation hospitals in Gharbeya Governorate, Egypt.
RESULTS
The mean age of the studied group was 41.73 ± 13.59, and 216 (50.8%) of them were males. One hundred and thirty one (30.8%) patients had ophthalmological manifestations. Among the entire patients, the most common ophthalmological presentation was conjunctivitis in 111 patients (26.1%), followed by neuro-retinal affection in 9 (2.1%), secondary fungal orbital cellulitis in 6 (1.4%), episcleritis in 3 (0.7%) and keratitis in 2 (0.5%) patients. All of the observed ophthalmological implications occurred either during the course of the disease (concurrent) or after recovery, except for the fungal orbital cellulitis which occurred only after recovery.
CONCLUSION
COVID-19 could cause different eye manifestations. Recovery from the main disease does not guarantee eye safety, especially in high-risk patients.
PubMed: 34819718
DOI: 10.2147/OPTH.S336600 -
Sisli Etfal Hastanesi Tip Bulteni 2019Preseptal cellulitis is an infection that affects the palpebra and the periorbital superficial tissue. This study is an evaluation of the clinical findings, treatment,...
OBJECTIVES
Preseptal cellulitis is an infection that affects the palpebra and the periorbital superficial tissue. This study is an evaluation of the clinical findings, treatment, and complications of patients hospitalized with preseptal cellulitis in a single clinic.
METHODS
The records of 29 patients with preseptal cellulitis who were hospitalized in the Şişli Hamidiye Etfal Education and Research Hospital Pediatric Infection Clinic between November 2012 and November 2017 were analyzed retrospectively.
RESULTS
Of the 29 cases, 34.5% (n=10) were female and 65.5% (n=19) were male. The mean age was 61.76±46.95 months, and the mean length of hospital stay was 4.03±2.04 days. Periorbital swelling (72.4%) was the most common cause of complaint at hospital admission, and periorbital hyperemia and edema were observed in 93.1% of the clinical findings. Nine (52.9%) of 17 cases with predisposing factors were sinusitis-related. A blood culture was obtained in 21 (72.4%) cases. Imaging methods were used in 9 (31%) cases to support the diagnosis. All of the patients received broad-spectrum intravenous antibiotic therapy during hospitalization. The mean duration of antibiotic use was 10.10±3.41 days, including after discharge. None of the patients developed complications related to preseptal cellulitis.
CONCLUSION
Preseptal cellulitis is a very common orbital infection, especially in childhood. Although it generally has a good prognosis, it can progress rapidly to the orbita and intracranial structures. An accurate clinical approach and rapid treatment can prevent the spread of infection and avoid serious complications.
PubMed: 32377117
DOI: 10.14744/SEMB.2018.75010 -
Journal of Clinical Medicine Jan 2019Sinonasal-related orbital infections (SROIs) are typically pediatric diseases that occur in 3⁻4% of children with acute rhinosinusitis. They are characterised by... (Review)
Review
Sinonasal-related orbital infections (SROIs) are typically pediatric diseases that occur in 3⁻4% of children with acute rhinosinusitis. They are characterised by various clinical manifestations, such as peri-orbital and orbital cellulitis or orbital and sub-periosteal abscesses that may develop anteriorly or posteriorly to the orbital septum. Posterior septal complications are particularly dangerous, as they may lead to visual loss and life-threatening events, such as an intracranial abscess and cavernous sinus thrombosis. Given the possible risk of permanent visual loss due to optic neuritis or orbital nerve ischemia, SROIs are considered ophthalmic emergencies that need to be promptly recognised and treated in an urgent-care setting. The key to obtaining better clinical outcomes in children with SROIs is a multi-disciplinary assessment by pediatricians, otolaryngologists, ophthalmologists, radiologists, and in selected cases, neurosurgeons, neurologists, and infectious disease specialists. The aim of this paper is to provide an overview of the pathogenesis, clinical manifestations, diagnosis, and treatment of pediatric SROIs, and to make some practical recommendations for attending clinicians.
PubMed: 30654566
DOI: 10.3390/jcm8010101 -
BMJ Open Dec 2019Skin and soft tissue infections of the eye can be classified based on anatomic location as either anterior to the orbital septum (ie, periorbital cellulitis) or...
INTRODUCTION
Skin and soft tissue infections of the eye can be classified based on anatomic location as either anterior to the orbital septum (ie, periorbital cellulitis) or posterior to the orbital septum (ie, orbital cellulitis). These two conditions are often considered together in hospitalised children as clinical differentiation is difficult, especially in young children. Prior studies have identified variation in management of hospitalised children with orbital cellulitis; however, they have been limited either as single centre studies or by the use of administrative data which lacks clinical details important for interpreting variation in care. We aim to describe the care and outcomes of Canadian children hospitalised with periorbital and orbital cellulitis.
METHOD AND ANALYSIS
This is a multisite retrospective cohort study including previously healthy children aged 2 months to 18 years admitted to hospital with periorbital or orbital cellulitis from 2009 to 2018. Clinical data from medical records from multiple Canadian hospitals will be collected, including community and academic centres. Demographic characteristics and study outcomes will be summarised using descriptive statistics, including diagnostic testing, antibiotic therapy, adjunctive therapy, surgical intervention and clinical outcomes. Variation will be described and evaluated using χ² test or Kruskal-Wallis test. Generalised linear mixed models will be used to identify predictors of surgical intervention and longer length of stay.
ETHICS AND DISSEMINATION
Approval of the study by the Research Ethics Board at each participating site has been obtained prior to data extraction. Study results will be disseminated by presentations at national and international meetings and by publications in high impact open access journals. By identifying important differences in management and outcomes by each hospital, the results will identify areas where care can be improved, practice standardised, unnecessary diagnostic imaging reduced, pharmacotherapy rationalised and where trials are needed.
Topics: Adolescent; Canada; Cohort Studies; Hospitalization; Humans; Infant; Multicenter Studies as Topic; Orbital Cellulitis; Research Design; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 31871262
DOI: 10.1136/bmjopen-2019-035206