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Arquivos Brasileiros de Oftalmologia Oct 2014Purpose: We reported on the clinical approaches of ophthalmology and otorhinolaryngology departments in the treatment of the orbital complications of sinusitis. We also...
Purpose: We reported on the clinical approaches of ophthalmology and otorhinolaryngology departments in the treatment of the orbital complications of sinusitis. We also included an in-depth literature review. Methods: We retrospectively reviewed the medical files of 51 patients from January 2008 to January 2014. The records were evaluated for age, gender, type of orbital complications, symptoms, predisposing factors, imaging studies, medical and surgical management, culture results, and follow-up information. SPSS version 15.0 software (Statistical Analysis, The Statistical Package for Social Sciences Inc, Chicago, IL) was used for the statistical analysis. Results: Fifty-one patients met the criteria, with available medical records, for the study (29 male, 22 female). Thirty-two (62.7%) were diagnosed with preseptal cellulitis and 19 (37.3%) with postseptal cellulitis. After a detailed evaluation, 15 were diagnosed with a subperiosteal abscess (SPA), and 4 were diagnosed with orbital cellulitis. The age and gender was similar for the two groups. Five patients with medial SPA were treated with endoscopic sinus surgery, one patient with inferior SPA was treated with external surgery, and six patients with other localizations were treated with a combination of endoscopic sinus surgery and external surgery. All patients presented with periorbital erythema and edema. The length of hospitalization and duration of symptoms were similar in both groups. Visual acuity was between 1/10 to 10/10 (mean 7/10) and statistically significant for preseptal and postseptal cellulitis groups (p<0.001). All patients received intravenous antibiotics upon the first day of admission. Conclusion: Orbital complications of acute sinusitis required intensive follow-up and a multidisciplinary approach. A contrast-enhanced paranasal sinus computerized tomography (CT) scan can detect the extent of the infection. An initial trial of intravenosus (IV) antibiotics may be appropriate when close monitoring is possible. Surgery may be indicated when there has been no improvement within 48 hours of intravenous treatment, loss of visual acuity (under 8/10), and a non-medial abscess.
PubMed: 25494374
DOI: 10.5935/0004-2749.20140074 -
JAMA Ophthalmology Jan 2021Critically ill patients with coronavirus disease 2019 (COVID-19) who are unresponsive to maximum optimal ventilator settings may be in a prone position for at least 16...
IMPORTANCE
Critically ill patients with coronavirus disease 2019 (COVID-19) who are unresponsive to maximum optimal ventilator settings may be in a prone position for at least 16 hours per day to improve oxygenation. This extended duration of prone positioning puts patients at risk of developing orbital compartment syndrome if direct pressure to the orbit and the globe occurs and concomitant protection of the eyes is not undertaken.
OBJECTIVE
To report 2 cases of orbital compartment syndrome, as well as optic disc edema and retinal hemorrhages, in the setting of prolonged prone positioning of patients in the intensive care unit during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS
The cases took place from April 27, 2020, to May 4, 2020, at a COVID-19 intensive care unit of a tertiary care hospital. Four of 16 patients in the intensive care unit required prolonged prone-position ventilation. A bedside eye examination was performed on 4 selected patients due to the observed presence of substantial periorbital edema.
MAIN OUTCOMES AND MEASURES
Intraocular pressures and fundus findings of 4 patients with periorbital edema.
RESULTS
Two of 4 patients who were in the prone position for extended periods of time had bilateral fundoscopic findings of optic disc edema and retinal hemorrhages, possibly consistent with a papillophlebitis. Additionally, both patients had a substantial increase in intraocular pressure of 2- to 3-fold in the prone position compared with the supine position.
CONCLUSIONS AND RELEVANCE
Prolonged prone positioning of patients with COVID-19 can be associated with elevated intraocular pressure from periorbital edema, direct compression on the eye, and increased orbital venous pressure. Orbital compartment syndrome can be avoided by the use of protective cushioning around the eyes and maintaining the patient's head position above heart level during prone positioning. Patients with COVID-19 may also develop papillophlebitis with optic disc edema and retinal hemorrhages, which may be associated with a hypercoagulable state caused by COVID-19. These observations suggest awareness for the possible presence of these ophthalmic findings while treating severely ill patients with COVID-19.
Topics: Adult; COVID-19; Compartment Syndromes; Critical Illness; Eye Protective Devices; Humans; Intraocular Pressure; Male; Middle Aged; Orbital Diseases; Patient Positioning; Prone Position; Respiration, Artificial; Time Factors; Treatment Outcome
PubMed: 33211075
DOI: 10.1001/jamaophthalmol.2020.4988 -
Brazilian Journal of Otorhinolaryngology 2017The proximity of the paranasal sinuses to the orbit and its contents allows the occurence of injuries in both primary or revision surgery. The majority of orbital...
INTRODUCTION
The proximity of the paranasal sinuses to the orbit and its contents allows the occurence of injuries in both primary or revision surgery. The majority of orbital complications are minor. The major complications are seen in 0.01-2.25% and some of them can be serious, leading to permanent dysfunction.
OBJECTIVE
The aim of this study was to determine the risk and type of ophthalmic complications among patients operated due to a chronic rhinosinusitis.
METHODS
This is a retrospective study of 1658 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with or without polyps or mucocele. Surgeries were performed under general anesthesia in all cases and consisted of polyps' removal, followed by middle metal antrostomy, partial or complete ethmoidectomy, frontal recess surgery and sphenoid surgery if necessary. The ophthalmic complications were classified according to type, frequency and clinical findings.
RESULTS
In our material 32.68% of the patients required revision surgery and only 10.1% had been previously operated in our Department. Overall complications occurred in 11 patients (0.66%). Minor complications were observed in 5 patients (0.3%) with the most frequent being periorbital ecchymosis with or without emphysema. Major complications were observed in one patient (0.06%) and were related to a lacrimal duct injury. Severe complications occurred in 5 cases (0.3%), with 2 cases and referred to a retroorbital hematoma, optic nerve injury (2 cases) and one case of extraocular muscle injury.
CONCLUSIONS
Orbital complications of endoscopic nasal surgery are rare. The incidence of serious complications, causing permanent disabilities is less than 0.3%. The most important parameters responsible for complications are extension of the disease, previous endoscopic surgery and coexisting anticoagulant treatment.
Topics: Adult; Aged; Chronic Disease; Eye Diseases; Female; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Paranasal Sinuses; Postoperative Complications; Retrospective Studies; Rhinitis; Sinusitis; Young Adult
PubMed: 27233691
DOI: 10.1016/j.bjorl.2016.04.006 -
Antibiotics (Basel, Switzerland) Sep 2022The delayed treatment of pediatric periorbital cellulitis may have severe consequences. In addition, the antibiotic efficacy against causative bacteria may change over...
The delayed treatment of pediatric periorbital cellulitis may have severe consequences. In addition, the antibiotic efficacy against causative bacteria may change over time, and it is important to understand the appropriate antibiotic options for effective treatment in pediatric patients. We compared the changes in cultured bacteria and drug susceptibility tests between two decades, 2010-2019 and 2000-2009, to establish antibiotics for empirical use. The patient characteristics, etiologies, culture sites, and isolated bacteria, and the antibiotic susceptibility tests of the admitted pediatric patients ( = 207) diagnosed with preseptal and orbital cellulitis during 2000 to 2019, were recorded. Insect/animal bites ( = 0.084) showed an increasing trend, and sinusitis ( = 0.016) showed a significant decrease in the past decades. The most common bacteria were , and methicillin-resistant (MRSA) infections increased in recent decades ( = 0.01). Moreover, we found that vancomycin was ideal for MRSA infections. The decreasing efficacy of oxacillin correlates with the increasing proportion of MRSA in pediatric periorbital cellulitis. Our study thus offers antibiotic choices against the most common isolates that can be administered before culture results are available.
PubMed: 36289946
DOI: 10.3390/antibiotics11101288 -
Cureus Jan 2022Herpes zoster infection is more frequent and severe in the immunocompromised population. Its incidence is significantly higher in this population when compared to...
Herpes zoster infection is more frequent and severe in the immunocompromised population. Its incidence is significantly higher in this population when compared to immunocompetent individuals. The authors present a case of an 88-year-old man with a history of arterial hypertension and myelodysplastic syndrome. The patient was evaluated in the emergency department (ED) for edema of the frontal facial region with left periorbital involvement and multiple purulent vesicles. He was diagnosed with viral infection by herpes zoster and was prescribed valaciclovir and deflazacort. He returned two days later due to an increase in the lesions affecting the left hemi-cranium, with decreased visual acuity and painless purulent drainage in the ipsilateral eye. The ophthalmological evaluation revealed exuberant edema with associated chemosis and involvement of the cornea of the affected eye. He was hospitalized and began antiviral therapy with intravenous acyclovir and chloramphenicol with topical ganciclovir. There was a progressive resolution of the skin lesions but no reversal of the loss of vision in the affected eye. Herpes zoster infection is more frequent and severe in the immunocompromised population. The clinical presentation is often similar to that of the immunocompetent population; however, it can have exuberant manifestations. The authors emphasize the need for close clinical monitoring of the immunocompromised patient with herpes zoster infection and review the role of corticosteroids when treating this particular population.
PubMed: 35004077
DOI: 10.7759/cureus.20908 -
Cureus Aug 2020Introduction Orbital infection is an ophthalmological emergency as it can lead to blindness and intracranial spread. Imaging is needed to determine the extent of the...
Introduction Orbital infection is an ophthalmological emergency as it can lead to blindness and intracranial spread. Imaging is needed to determine the extent of the infection, to localize an abscess, and for surgical planning. The role of magnetic resonance imaging (MRI) is well established in the evaluation of orbital pathologies, including orbital cellulitis and abscess, mainly due to its ability to evaluate early intracranial involvement. The objective of the study was to highlight the spectrum of MR imaging findings and the pattern of spread in fifteen patients with orbital cellulitis. Methods A prospective study was conducted in a tertiary care hospital. Fifteen patients of all age groups, of either sex, presenting with clinical findings suggestive of orbital cellulitis, referred for MRI of orbits, were included in the study. Written informed consent was obtained prior to the study. Patients' demographic data such as age and gender, associated co-morbidities, complications, and the pattern of spread of disease on MRI were recorded and evaluated. Descriptive statistics were used. Results Orbital/periorbital abscess was found to be the most common complication of orbital cellulitis (eight cases, 53.3%), followed by optic neuritis/perineuritis (four cases, 26.67%), intracranial involvement (four cases, 26.67%), dacryoadenitis (three cases, 20%) and cavernous sinus thrombophlebitis (three cases, 20%). Seven cases (46.67%) had right orbital involvement. Sinusitis was found to be the most common predisposing factor. Amongst the cases associated with sinusitis, the commonest inflamed paranasal sinus was found to be the ethmoid sinus (twelve cases). Amongst the fifteen cases of orbital/periorbital cellulitis, there were only two cases of isolated preseptal cellulitis (13.33%), five cases of postseptal cellulitis (33.33%) and eight cases of both preseptal and postseptal orbital cellulitis (53.33%). Conclusion MRI is the imaging modality of choice in the evaluation of orbital cellulitis because of its superior soft tissue and contrast resolution. It is vital to evaluate the extent of the orbital infection, underlying paranasal sinus involvement, as well as detect complications of orbital cellulitis, especially intracranial spread.
PubMed: 32923259
DOI: 10.7759/cureus.9663 -
Journal of Feline Medicine and Surgery Feb 2023This study aimed to determine the prevalence and clinical presentation of ocular diseases in cats in South Korea.
OBJECTIVES
This study aimed to determine the prevalence and clinical presentation of ocular diseases in cats in South Korea.
METHODS
Medical records of cats that were presented for ophthalmology services at Seoul National University Veterinary Medical Teaching Hospital between 2009 and 2021 were reviewed. Collected data included patient signalment, clinical signs, diagnosed ophthalmic disorders and affected eyes. Odds ratios were calculated when a variable was over-represented.
RESULTS
This study recorded a total of 358 eyes (180 cats). Domestic shorthair (DSH) was the most common breed (42.2%), followed by Persian (13.9%) and Scottish Fold (8.3%); 14 (35.6%) other breeds were recorded. The median age at the first presentation was 3 years (range 2 months to 17 years); the highest percentage of cats presented at <1 year (21.7%). The most affected ocular structure was the cornea (28.5%), followed by the lens (19.9%) and uvea (15.3%). The most frequently reported disorders were corneal ulceration (13.2%), uveitis (11.9%), incipient cataract (11.0%), keratitis (5.4%), secondary glaucoma (5.2%) and sequestrum (4.2%). The Exotic Shorthair breed was significantly over-represented with regard to entropion and periorbital fat prolapse ( <0.01). The DSH breed was significantly over-represented with regard to eyelid agenesis ( <0.01).
CONCLUSIONS AND RELEVANCE
This study provides prevalence information for feline ophthalmic diseases and could contribute important data for diagnosing, treating and preventing feline ophthalmic diseases in South Korea.
Topics: Cats; Animals; Retrospective Studies; Prevalence; Corneal Ulcer; Cataract; Republic of Korea; Cat Diseases
PubMed: 36779421
DOI: 10.1177/1098612X231151478 -
Indian Journal of Ophthalmology Feb 2022To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital...
Orbital magnetic resonance imaging profile and clinicoradiological correlation in COVID-19-associated rhino-orbital-cerebral mucormycosis: A single-center study of 270 patients from North India.
PURPOSE
To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital involvement and perform a clinicoradiological correlation.
METHODS
A cross-sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA-ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs.
RESULTS
Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter-rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (κ 0.621) and 93.70% (κ 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively.
CONCLUSION
Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation.
Topics: COVID-19; Cross-Sectional Studies; Female; Humans; India; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Orbital Cellulitis; Orbital Diseases; SARS-CoV-2
PubMed: 35086254
DOI: 10.4103/ijo.IJO_1652_21 -
Frontiers in Immunology 2024To assess the impact conferred by variants on the clinical spectrum of patients with systemic autoinflammatory diseases (SAIDs) in Greece. (Review)
Review
OBJECTIVE
To assess the impact conferred by variants on the clinical spectrum of patients with systemic autoinflammatory diseases (SAIDs) in Greece.
METHODS
Consecutive patients (n=167) with confirmed SAIDs who underwent screening by next generation sequencing (NGS) targeting 26 SAID-associated genes, and carried at least one gene variant, were retrospectively studied. The demographic, clinical and laboratory parameters were recorded.
RESULTS
In total, 24 rare variants in 23/167 patients (14%) were detected. Notably, 18 patients had at least one co-existing variant in 13 genes other than . Nine patients had juvenile- and 14 adult-onset disease. All patients presented with symptoms potentially induced by the variants. In particular, the candidate clinical diagnosis was Yao syndrome (YAOS) in 12 patients (7% of the whole SAID cohort). The clinical spectrum of patients with YAOS (mean episode duration 8 days) was fever (n=12/12), articular symptoms (n=8), gastrointestinal symptoms (n=7; abdominal pain/bloating in 7; diarrhea in 4; oral ulcers in 3), serositis (n=7), and rash (n=5), while the inflammatory markers were elevated in all but one patient. Most of these patients showed a poor response to nonsteroidal anti-inflammatory drugs (n=7/9), colchicine (n=6/8) and/or anti-TNF treatment (n=3/4), while a complete response was observed in 6/10 patients receiving steroids and 3/5 on anti-IL1 treatment. Another 8 patients were diagnosed with either FMF (n=6) or PFAPA syndrome (n=2) presenting with prominent diarrhea (n=7), oral ulcers (n=2), periorbital swelling and sicca-like symptoms (n=1), or maculopapular rash (n=1). One patient had a clinically undefined SAID, albeit characterized by oral ulcers and diarrhea. Finally, one patient presented with chronic relapsing urticaria with periorbital edema and inflammatory markers, and another one had a Crohn-like syndrome with good response to anti-IL-1 but refractory to anti-TNF treatment.
CONCLUSION
variants were detected in 1 out of 7 SAID patients and seem to have an impact on disease phenotype and treatment response. Further studies should validate combined molecular and clinical data to better understand these distinct nosological entities.
Topics: Adult; Animals; Humans; Hereditary Autoinflammatory Diseases; Retrospective Studies; Oral Ulcer; Simian Acquired Immunodeficiency Syndrome; Tumor Necrosis Factor Inhibitors; Diarrhea; Exanthema; Nod2 Signaling Adaptor Protein
PubMed: 38348033
DOI: 10.3389/fimmu.2024.1342668 -
Evidence-based Dentistry Jan 2021Data sources PubMed/Medline, Biomed Central, Embase, Thai Journals and the Cochrane library.Study selection Reports or studies dealing with the craniomaxillofacial (CMF)...
Data sources PubMed/Medline, Biomed Central, Embase, Thai Journals and the Cochrane library.Study selection Reports or studies dealing with the craniomaxillofacial (CMF) manifestations of COVID-19 were selected.Data extraction and synthesis The reviewers extracted data from the included studies; however, being a meta-narrative review, it was not deemed fit to contact authors for unpublished work, conduct a meta-analysis, search for unpublished data or search for studies in languages different from English, German, French and Thai. The primary variable for prediction was set as the COVID-19 infection, with the primary outcome variable being manifestation in the CMF region. Parameters of a clinical, demographic, investigative and therapeutic nature were the other included variables. Subsequently, the reports and abstracted data were reviewed for study design, author names, country, size of the sample, level of evidence, signs/symptoms, treatment undertaken and investigations conducted. Studies exhibiting the highest level of evidence were included eventually. As deemed appropriate, uni/bivariate and descriptive statistics were applied.Results Cumulatively, 101 publications were included in the meta-narrative after due screening, the data of which was further divided into five groups of: 1) nose/paranasal sinus/skull base; 2) mouth/throat; 3) periorbital/ocular tissue; 4) skin; and 5) ear.Conclusions The majority of data pertaining to CMF manifestations of COVID-19 qualifies as a low level of evidence. With the exception of taste/smell dysfunction, most CMF manifestations are nonspecific and can be diagnosed by CMF surgeons and dentists, which underscores their role in battling the pandemic.
Topics: COVID-19; Humans; Pandemics; SARS-CoV-2
PubMed: 34172913
DOI: 10.1038/s41432-021-0177-z