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Ohana O, Maeng MM, Johnson TE. Orbital Abscess Secondary to Nasolacrimal Duct Obstruction in an Extremely Preterm Infant. Ophthalmic Plast Reconstr Surg 2024; 40:e14-e16. [PMID: 38241629 DOI: 10.1097/iop.0000000000002521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Orbital abscesses are rarely encountered in children younger than 1 year. The literature is limited to isolated case reports and a few case series. Most such cases are reported in infants born at term, with the earliest reported gestational birth age at 34 weeks. Children are more prone to orbital cellulitis compared with adults due to their underdeveloped sinuses and immature immune systems, and the origin is most commonly an ethmoid sinus infection. Orbital cellulitis secondary to dacryocystitis is even less common, with only a few isolated cases reported in infants and children. Herein, the authors present a case of a large extraconal and intraconal orbital abscess secondary to nasolacrimal duct obstruction and dacryocystitis in an extremely preterm infant. We discuss the diagnosis and multidisciplinary management of this challenging case.
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Affiliation(s)
- Oded Ohana
- Oculoplastic Division, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
- Department of Ophthalmology, "Meir" Medical Center, Kfar-Saba, Israel
| | - Michelle M Maeng
- Oculoplastic Division, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
- Department of Ophthalmology and Visual Sciences, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Thomas E Johnson
- Oculoplastic Division, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
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Balaraj S, Sridhar A, Sajith M, Channegowda C. Transnasal endoscopic drainage of neonatal orbital abscess. BMJ Case Rep 2023; 16:e255145. [PMID: 37802596 PMCID: PMC10565282 DOI: 10.1136/bcr-2023-255145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Neonatal orbital complications are rare and potentially fatal, demanding prompt diagnosis and adequate treatment. A 25-day-old neonate presented with rapidly progressive orbital complications as evidenced by proptosis, chemosis, lid oedema and restricted eye movements, developing within 3 days. There was no significant medical history or risk factors for developing infection. An initial conservative approach with antimicrobial therapy failed to show any resolve. An MRI brain, orbits and paranasal sinuses demonstrated that there were features suggestive of right orbital cellulitis with possibility of abscess formation with right ethmoidal mucoinflammatory disease and mass effect on the optic nerve causing stretching and compression by the surrounding inflammation.The patient was treated successfully with transnasal endoscopic drainage and decompression. Endoscopic access was challenging owing to the restrictive anatomy. Postoperatively, the patient showed improvement, with gradual decrease in proptosis and resolve in eye movements.
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Affiliation(s)
| | | | - Milu Sajith
- ENT, MS Ramaiah Medical College, Bangalore, Karnataka, India
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Kulkarni V, Sundaram V, Sameeksha TH. Overwhelming orbital cellulitis in a neonate. BMJ Case Rep 2023; 16:e252390. [PMID: 37491125 PMCID: PMC10373664 DOI: 10.1136/bcr-2022-252390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
This article discusses a rare ophthalmic manifestation of neonatal bacterial infection and its management, including surgical drainage. The case discussed is that of a neonate who presented with rapidly progressing ophthalmic symptoms suggestive of orbital cellulitis. The neonate also had extensive intracranial involvement and had spread to contiguous structures causing a temporal lobe abscess. As there was no local injury, a haematogenous spread was strongly considered. With blood culture and pus culture yielding the growth of Staphylococcus aureus, systemic antibiotics and surgical interventions were required to successfully manage the neonate. Through this case report, we emphasise that orbital infections are grave in neonates and may culminate into devastating intracranial complications; hence, it necessitates appropriate medical and surgical interventions right from hospital admission.
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Affiliation(s)
- Venu Kulkarni
- Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Venkataseshan Sundaram
- Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Orbital cellulitis. Surv Ophthalmol 2018; 63:534-553. [DOI: 10.1016/j.survophthal.2017.12.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 12/12/2022]
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Neonatal Orbital Abscess Secondary to Pseudomonas Aeruginosa Conjunctivitis. Ophthalmic Plast Reconstr Surg 2016; 33:e64-e66. [PMID: 27464455 DOI: 10.1097/iop.0000000000000754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pseudomonas aeruginosa conjunctivitis, although rare in healthy infants, may cause serious ocular and systemic complications. A 30-day-old, otherwise healthy male infant was referred with the diagnosis of right orbital abscess. The patient had been diagnosed as having Pseudomonas conjunctivitis 9 days previously at the referring center. Despite antibiotic treatment, his ocular findings had worsened and marked proptosis had developed. Other examination findings were ptosis, restriction of eye movements, periorbital erythema, and chemosis. Radiologic studies showed a large, homogenous mass with a thick capsule in the lateral retrobulbar orbit. The abscess was drained through a lateral orbitotomy. A culture of the abscess yielded P. aeruginosa. After surgery, the ocular findings improved rapidly without any complication. No other focus of infection or immune system abnormality was found. The patient did not experience any other significant disease during a follow up of 23 months.
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Abstract
Orbital complications due to ethmoiditis are rare in neonates. A case of orbital abscess due to acute ethmoiditis in a 28-day-old girl is presented. A Successful outcome was achieved following antimicrobial therapy alone; spontaneous drainage of the abscess occurred from the lower lid without the need for surgery. From this case report, we intend to emphasize on eyelid retraction as a sign of neonatal orbital abscess, and to review all the available literature of similar cases.
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Yang E, Fisher M, Servat J, Levin F. Neonatal orbital abscess after sinus surgery: case report and brief review. Orbit 2013; 32:312-4. [PMID: 23875775 DOI: 10.3109/01676830.2013.803127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Orbital abscess formation in neonates is rare, with only 12 cases reported in the literature. We present a case of orbital cellulitis with orbital abscesses following repair of congenital choanal atresia in a 2-week-old neonate. This is the first reported case of an orbital abscess following a sinus procedure in a neonate.
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Affiliation(s)
- Elizabeth Yang
- Department of Ophthalmology, Yale-New Haven Hospital , New Haven, Connecticut , USA
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Lin CY, Chiu NC, Lee KS, Huang FY, Hsu CH. Neonatal orbital abscess. Pediatr Int 2013; 55:e63-6. [PMID: 23782382 DOI: 10.1111/ped.12020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 09/10/2012] [Accepted: 10/31/2012] [Indexed: 11/26/2022]
Abstract
Orbital abscess is life-threatening and rare in children. Reported herein is a term male neonate who had methicillin-resistant Staphylococcus aureus orbital abscess, and a literature review of this disease. A total of 16 neonates diagnosed with neonatal orbital abscess are reported in the literature. There is a mild male predilection and two neonates were delivered prematurely. Leukocytosis, fever, ethmoiditis and associated upper respiratory tract infection were found in approximately half of them. Eight neonates had sepsis and 14 patients underwent surgical intervention. One patient died. Staphylococcus aureus was identified in 14 out of 17 patients. Neonatal orbital abscess is rarely encountered but may be fatal. Although streptococci are prevalent in childhood orbital infection, S. aureus was predominant in neonatal orbital abscess in the present series. Appropriate antimicrobial therapy against S. aureus is essential in treating neonatal orbital abs ess. This case suggests that a higher initial dose of vancomycin may be an effective and safe strategy for severe S. aureus infection in neonates.
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Affiliation(s)
- Chien-Yu Lin
- Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan
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Affiliation(s)
- Apjit Kaur
- Department of Ophthalmology, Chhatrapati Shahuji Maharaj University, Lucknow, Uttar Pradesh, India
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Lei TH, Huang YC, Chu YC, Lee CY, Lien R. Orbital cellulitis caused by community-associated methicillin-resistant Staphylococcus aureus in a previously healthy neonate. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 46:136-8. [DOI: 10.1016/j.jmii.2012.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/27/2011] [Accepted: 01/04/2012] [Indexed: 11/26/2022]
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Gonzalez MO, Durairaj VD. Understanding pediatric bacterial preseptal and orbital cellulitis. Middle East Afr J Ophthalmol 2011; 17:134-7. [PMID: 20616919 PMCID: PMC2892128 DOI: 10.4103/0974-9233.63074] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pediatric preseptal and orbital cellulitis are infectious disorders that result in periorbital inflammation. Preseptal cellulitis is often associated with breaches in the skin barrier whereas orbital cellulitis is commonly associated with paranasal sinusitis. Orbital cellulitis may be associated with subperiosteal abscess. It is important to distinguish between preseptal from orbital cellulitis. Clinical examination and diagnostic imaging are useful in determining appropriate management. Patients are usually treated with broad spectrum antibiotics and surgery when indicated.
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Affiliation(s)
- Mithra O Gonzalez
- Department of Ophthalmology, Division of Oculoplastic and Orbital Surgery, Rocky Mountain Lions Eye Institute, University of Colorado, Aurora, CO, USA
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Pediatric subperiosteal orbital abscess secondary to acute sinusitis: a 5-year review. Am J Otolaryngol 2011; 32:62-8. [PMID: 20031268 DOI: 10.1016/j.amjoto.2009.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 09/29/2009] [Accepted: 10/12/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Subperiosteal orbital abscesses (SPOAs) secondary to acute sinusitis are rare occurrences in the pediatric age group, more so in the neonatal period. Here, a rare case of SPOA in a 38-day-old newborn later drained via endoscopic sinus surgery is included also. This review describes the demographic data, clinical history, treatment, microbiology results, complications, and outcome. METHODS The admission records for all the patients who were admitted to the Pediatric Surgical Ward in Sarawak General Hospital, Kuching, Malaysia, between January 2004 and May 2009 were retrospectively reviewed. Records of patients who presented with preseptal cellulitis, orbital cellulitis, subperiosteal abscess (extraconal), orbital abscess (intraconal), and cavernous sinus thrombosis were closely studied. Ophthalmology consultations were obtained in all these cases. Ultimately, 3 patients having SPOA secondary to acute sinusitis were selected for this review. RESULTS All patients were male with rapid onset of periorbital signs, absence of purulent rhinorrhea, and presence of significant thrombocytosis (exceeding 500 × 10(9)/L). The 38-day-old newborn had mixed infection of methicillin-resistant coagulase-negative Staphylococcus bacteremia and local Acinetobacter eye infection with Staphylococcus aureus in the SPOA. All had medially located SPOA that was adequately drained via endoscopic sinus surgery, resulting in full recovery. CONCLUSION Newborns with preexisting risk factors and immature immunity are at risk of severe and rare infections. Contrast-enhanced paranasal sinus computed tomographic scan is mandatory and reliable to differentiate preseptal and postseptal orbital infection, as both conditions can present similarly and rapidly deteriorate. In the contrast-enhanced computed tomography-demonstrable SPOA, endoscopic sinus surgery drainage of the abscess proved to be safe and reliable as the main treatment modality. All patients recovered well without complications.
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Cheng S, Vu P. Pott's puffy tumor in a premature neonate: the new youngest case reported in the post-antibiotic era. Orbit 2009; 28:412-414. [PMID: 19929672 DOI: 10.3109/01676830903104736] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
An extreme premature infant born at 25 weeks post menstrual age (PMA) presented at PMA of 32 weeks with non-multiresistant methicillin resistant Staphylococcus aureus (MRSA) Pott's puffy tumor (PPT) involving both orbital and intracranial extension is described here. This is the youngest case of PPT ever reported in the antibiotic era.
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Affiliation(s)
- Sean Cheng
- Mater Children's Hospital, Ophthalmology, Raymond Terrace, South Brisbane, QLD 4101, Australia
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Wagh VB, Kabra SK, Kashyap S, Avyact A, Pathak H, Sharma V, Kai S, Betharia SM. Rare presentation of fungal orbital cellulitis in an immunocompetent infant. J Pediatr Ophthalmol Strabismus 2007; 44:127-9. [PMID: 17410966 DOI: 10.3928/01913913-20070301-08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 3-month-old infant presented with unilateral proptosis. Ophthalmic and physical examinations, computed tomography, and histopathologic examination of a biopsy specimen were performed. Histopathologic examination confirmed fungal orbital cellulitis. The patient responded to 6 weeks of antifungal therapy. Fungal orbital cellulitis should be included in the differential diagnosis for infants with proptosis.
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Affiliation(s)
- Viyay B Wagh
- Dr Rajendra Prasad Center for Ophthalmic Sciences
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Wane AM, Ba EA, Ndoye-Roth PA, Kameni A, Demedeiros ME, Dieng M, Ndiaye MR, Ndiaye PA, Ben Nasr S, Wade A. Une expérience sénégalaise des cellulites orbitaires. J Fr Ophtalmol 2005; 28:1089-94. [PMID: 16395202 DOI: 10.1016/s0181-5512(05)81143-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To show the etiological, clinical, and epidemiological aspects of orbital cellulitis at the ophthalmological clinic of A. le Dantec hospital. PATIENTS AND METHOD This is a retrospective study conducted from January 1994 to October 2003. Sixty-eight patient records were used. We noted patients' civil status, past medical history, clinical and paraclinical examinations, treatment received before and at admission to the clinic, and progression. RESULTS The incidence of orbital cellulitis was 8.9 cases per year. The average age of patients was 18 years and the sex ratio 2.78 in favor of males. Patients were hospitalized for a mean of 11 days. The fever was often stopped at admission. All patients had violent retrobulbar pain, associated with inflammatory exophthalmos in 77.8% of cases, and ophthalmoplegia in 67.2%. Two cases of diplopia were noted; 57.5% had sinusitis. Streptococcus was the bacterium found most frequently. In hospital, all patients received three antibiotics (ampicillin, aminoglycoside, metronidazole) and prednisone. In 51.5% of the cases, surgical treatment was necessary. Progression was favorable in 55.88% of the cases. Three patients died and 18 cases of blindness were noted. CONCLUSION Orbital cellulitis is a young people's disorder with serious complications. This medical emergency requires a combination of effective antibiotics and a corticosteroid. Treating the source of infections is essential to avoid recurrence. In our practice, these three drugs in association in first intention was beneficial without an antibiogram.
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Affiliation(s)
- A M Wane
- Clinique Ophtalmologique, EPS Hôpital Aristide le Dantec, Sénégal.
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Reichert B, Birrell G, Bignardi G. Severe non-pneumonic necrotising infections in children caused by Panton-Valentine leukocidin producing Staphylococcus aureus strains. J Infect 2005; 50:438-42. [PMID: 15907553 DOI: 10.1016/j.jinf.2004.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2004] [Indexed: 10/26/2022]
Abstract
Two cases of infection with Panton-Valentine Leukocidin (PVL) producing strains of Staphylococcus aureus are reported. A 15-year-old insulin dependent diabetic developed toxic shock syndrome and an abscess in the deep tissue around his left hip. A 34-day-old infant presented with a right orbital cellulitis with an intra-orbital collection and septicaemia. In both cases PVL-producing strains of Staphylococcus aureus were isolated. Both surgery and prolonged antibiotic combination regimens were required to eradicate the infection. The cases reported here demonstrate the wide range of clinical presentations seen with PVL producing strains, which have so far been mainly associated with furuncles and necrotising pneumonia.
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Affiliation(s)
- B Reichert
- Department of Paediatrics, Sunderland Royal Hospital, Kayll Rd, Sunderland SR4 7TP, UK.
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Peytral C, Chevalier E. Complications ophtalmologiques en pathologie oto-rhino-laryngologique. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.emcorl.2004.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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