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Singh A, Aggarwal K, Lal P, Kumar M, G S T. Aeromonas hydrophila orbital cellulitis as post cesarean sepsis-An unthinkable eye opener. Int J Gynaecol Obstet 2024; 165:840-841. [PMID: 38247226 DOI: 10.1002/ijgo.15376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/05/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
SynopsisPeripartum orbital cellulitis and pan ophthalmitis are rare complications. Here we report one such case and the need for aggressive management of postpartum infections especially post cesarean.
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Affiliation(s)
- Anuradha Singh
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Kiran Aggarwal
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Prabha Lal
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Mansi Kumar
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
| | - Triveni G S
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India
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Zloto O, Verity DH, Das-Bhaumik RG. Severe orbital cellulitis in a healthy man. Clin Exp Optom 2024; 107:103-104. [PMID: 36598141 DOI: 10.1080/08164622.2022.2156773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/04/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Ofira Zloto
- Adnexal Department, Moorfields Eye Hospital, London, UK
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Bliss A, Craft A, Haber J, Inger H, Mousset M, Chiang T, Elmaraghy C. Visual outcomes following orbital decompression for orbital infections. Int J Pediatr Otorhinolaryngol 2024; 176:111824. [PMID: 38134589 DOI: 10.1016/j.ijporl.2023.111824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To analyze the visual outcomes and sequelae of endonasal intervention for orbital infections. INTRODUCTION Orbital infections pose a serious threat to vision in the pediatric population and can result in complications such as blindness, diplopia, intracranial involvement, and death. [1] Orbital decompression by endonasal intervention is a common treatment to address a variety of orbital infections including orbital cellulitis, orbital abscesses, and subperiosteal abscesses. [2] The outcomes of visual sequelae such as loss or limitation of visual acuity, extraocular movements, and increased intraocular pressure following orbital decompression via endonasal intervention have not been sufficiently investigated in the current literature. METHODS This retrospective cohort study was performed at our tertiary care pediatric hospital using data from 69 patients aged 0-18 years who were admitted between 2008 and 2018. Data was extracted from the electronic medical record system. RESULTS Following endoscopic sinus surgery, symptoms of orbital infection improved throughout the cohort. Improvement in visual acuity is demonstrated by a statistically significant decrease in the average logMAR value in both the right and left eye (P = 0.002 and P = 0.028 respectively). There was also a significant improvement to normal values postoperatively for patients who initially presented with abnormal tonometry, extraocular movement, and the appearance of eyelids and eyelashes. CONCLUSION There is no decline or loss of vision with otolaryngology surgical intervention for orbital cellulitis in our cohort. This retrospective chart review demonstrates the efficacy of surgical intervention on overall visual outcomes following endonasal intervention for orbital infections such as orbital cellulitis, orbital abscesses, and subperiosteal abscesses.
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Affiliation(s)
- Alessandra Bliss
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Aaron Craft
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jordan Haber
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hilliary Inger
- Dept of Pediatric Ophthalmology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marike Mousset
- Dept of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tendy Chiang
- Dept of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA; Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- Dept of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA.
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Kais A, McArdle E, Chaiban R, Cui R, Makary CA, Ramadan HH. Role of Acute Rhinosinusitis in Periorbital Infections in Children. Int J Pediatr Otorhinolaryngol 2024; 176:111813. [PMID: 38043186 DOI: 10.1016/j.ijporl.2023.111813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE Periorbital cellulitis in children are commonly caused by acute rhinosinusitis (ARS). This study investigated the association of ARS and the severity of periorbital cellulitis in children. STUDY DESIGN Retrospective case-control study of children with periorbital cellulitis with ARS versus periorbital cellulitis without ARS. SETTING Patients were seen at West Virginia University Children's Hospitals between August 2011 to August 2022. METHODS Patients were divided into cases and controls based on presence or absence of ARS. ARS was defined based on clinical symptoms with objective presence of disease on CT scan. Patients' characteristics, treatment, hospital length of stay, and readmission were collected. RESULTS The sample consisted of 118 pediatric patients with orbital cellulitis. Patients with ARS were younger than patients without ARS (6.3 vs 8.5, p = 0.025), however there were no sex differences between two groups (p = 0.540). The ARS group had higher incidence of postseptal cellulitis (51.5% vs 9.6%, p < 0.001). As compared to patients without ARS, patients with ARS were more likely to be admitted (p < 0.001), have a longer length of stay (median of 3.5 days vs 0.5 days, p < 0.001), require IV antibiotics (95.3% vs 54.9%, p < 0.001), and require surgical intervention (23.1% vs 5.8%, p < 0.001). Readmission rate was similar between the two groups. CONCLUSION Children presenting with acute periorbital cellulitis who have ARS tend to have more severe infection requiring higher level of care. ARS should be assessed and incorporated into the plan of care of pediatric patients with periorbital infections.
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Affiliation(s)
- Amani Kais
- West Virginia University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA
| | - Erica McArdle
- West Virginia University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA
| | - Rafka Chaiban
- West Virginia University School of medicine, Department of Pediatrics, P.O. Box 9100, Morgantown, WV, 26506-9600, USA
| | - Ruifeng Cui
- West Virginia University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA
| | - Chadi A Makary
- West Virginia University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA.
| | - Hassan H Ramadan
- West Virginia University School of Medicine, Department of Otolaryngology - Head and Neck Surgery, P.O. Box 9200, Morgantown, WV, 26506, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Preda MA, Sarafoleanu C, Mușat G, Preda AA, Lupoi D, Barac R, Pop M. Management of oculo-orbital complications of odontogenic sinusitis in adults. Rom J Ophthalmol 2024; 68:45-52. [PMID: 38617730 PMCID: PMC11007555 DOI: 10.22336/rjo.2024.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction: Odontogenic maxillary sinusitis (OMS) is an infectious inflammatory pathology caused by a dental condition. Considering the anatomical relations with the orbit, maxillary sinus infection can easily spread, evolving into severe oculo-orbital complications that can sometimes be life-threatening. Material and methods: We performed a retrospective study of over 2 years, examining the data of 18 patients diagnosed with OMS with oculo-orbital complications. The patients were evaluated regarding their dental history, symptoms, clinical and endoscopic findings, ophthalmologic evaluation, bacteriologic tests, computed tomography (CT) imaging, medical and surgical treatment, and outcomes. Results: The age of the patients was between 24 and 65 years old with an almost equal gender distribution: 10 female and 8 male patients. From the total, 7 patients had type II diabetes, 2 of whom were insulin-dependent, 1 patient had thrombophilia and 2 patients had renal failure with peritoneal dialysis. Regarding the type of oculo-orbital complications, 10 patients were diagnosed with preseptal cellulitis and 8 with orbital cellulitis. Just 5 patients with orbital cellulitis required surgical treatment and orbitotomy was performed, followed by endonasal endoscopic drainage. The evolution after surgical treatment was favorable for all operated patients. Discussions: Oculo-orbital complications of OMS are typically more severe than those of rhinogenic sinusitis because anaerobic bacteria are involved. Immunosuppression represents a favorable environment for the development of OMS and its complications, diabetes being the most common risk factor. A negative prognostic feature is the appearance of ophthalmological symptoms in both eyes, so visual function may be reduced. The treatment of oculo-orbital complications of OMS is urgent and depends on a broad-spectrum antibiotic therapy associated or not with surgical intervention. Conclusions: The diagnosis of oculo-orbital complications of OMS is complex and requires clinical experience as well as extensive medical knowledge to treat both the cause and the consequences of the conditions quickly and effectively. The proper management of oculo-orbital complications is based on a multidisciplinary team: ophthalmology, ENT, dentistry, imaging, and laboratory. Abbreviations: OMS = odontogenic maxillary sinusitis, CT = computed tomography, ENT = ear-nose-throat, MRI = magnetic resonance imaging, HNS = head and neck surgery.
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Affiliation(s)
- Mihai Alexandru Preda
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- ENT Department, "Sf. Maria" Clinical Hospital, Bucharest, Romania
| | - Codruț Sarafoleanu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- ENT Department, "Sf. Maria" Clinical Hospital, Bucharest, Romania
| | - Gabriela Mușat
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- ENT Department, "Sf. Maria" Clinical Hospital, Bucharest, Romania
| | - Andreea-Alexandra Preda
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Rheumatology Department, "Sf. Maria" Clinical Hospital, Bucharest, Romania
| | - Daniel Lupoi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- ENT Department, "Sf. Maria" Clinical Hospital, Bucharest, Romania
| | - Ramona Barac
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Department, Clinical Emergency Eye Hospital, Bucharest, Romania
| | - Monica Pop
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Department, Clinical Emergency Eye Hospital, Bucharest, Romania
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Vloka C, Perera C, Ng J. Non-visual complications of orbital cellulitis (NVCOC) in pediatric vs adult populations. Orbit 2023; 42:587-591. [PMID: 36530041 DOI: 10.1080/01676830.2022.2155196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE There have been many publications evaluating the visual outcomes of patients treated for orbital cellulitis. The aim of this study was to evaluate non-visual complications of post-septal orbital cellulitis (NVCOC) present 30 days after discharge from index hospitalization. METHODS This was an IRB-approved, retrospective chart review. RESULTS Ninety patients (45 pediatric, 45 adults) were identified with OC. NVCOC were significantly more common in adult patients as compared to children (40.0% vs 15.6% respectively; p < 0.05). The most common NVCOC among children was persistent ptosis, while clinically significant scarring was most common in adults. NVCOC were less persistent in children as compared to adults with 71.4% of complications in children resolving spontaneously by 6 month follow up as compared to 11.1% adults. (p < 0.05). The only statistically significant risk factor identified for the development of NVCOC in children and adults was the presence of ICE (intracranial extension) during index hospitalization (p < 0.05) and the presence of an infected orbital implant (p < 0.05) respectively. CONCLUSIONS Adult patients experience NVCOC complications more often than children. Furthermore, the nonvisual complications in children are more likely to resolve spontaneously than those in adults. The intracranial spread of infection is a significant risk factor for late complications in children. The presence of an orbital wall/floor implant is a significant risk factor for late complications in adults. There are many differences in the etiology, pathophysiology, and course of NVCOC in children and adults, so information on these two populations should be reported separately.
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Affiliation(s)
- Caroline Vloka
- Department of Ophthalmology, Colorado University, Aurora, Colorado, USA
| | - Chandrashan Perera
- Department of Ophthalmic AI Research, Stanford University, Palo Alto, California, USA
| | - John Ng
- Department of Ophthalmology, Casey Eye Institute, Portland, Oregon, USA
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Rodriguez A, Ahmed K, Tiwari N, Ramasubramanian A. Orbital cellulitis with panophthalmitis and scleral necrosis - a case report. BMC Ophthalmol 2023; 23:452. [PMID: 37957590 PMCID: PMC10641989 DOI: 10.1186/s12886-023-03193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Orbital cellulitis is common in young children and is often secondary to coexisting sinus disease. Coexisting orbital cellulitis and panophthalmitis is a rare clinical event and usually occurs secondary to trauma or from an endogenous source. CASE PRESENTATION A febrile 2-year-old male presented with periorbital inflammation and exudative retinal detachment. Imaging showed acute sinusitis and extensive orbital cellulitis. Because of progressive scleral thinning, the patient underwent enucleation. CONCLUSION We present a case of concurrent orbital cellulitis, panophthalmitis, and scleral necrosis in an immunocompetent pediatric patient. Timely intervention is important to prevent life threatening complications with the rare occurrence of coexistent orbital cellulitis and panophthalmitis.
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Affiliation(s)
- Aurora Rodriguez
- Phoenix Children's Hospital, 1920 E Cambridge Ave, 85,006-1464, Phoenix, AZ, United States of America
| | - Kamran Ahmed
- Phoenix Children's Hospital, 1920 E Cambridge Ave, 85,006-1464, Phoenix, AZ, United States of America
| | - Nishant Tiwari
- Phoenix Children's Hospital, 1920 E Cambridge Ave, 85,006-1464, Phoenix, AZ, United States of America
| | - Aparna Ramasubramanian
- Phoenix Children's Hospital, 1920 E Cambridge Ave, 85,006-1464, Phoenix, AZ, United States of America.
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Alsaggaf K, Aljuhani H, Aljahdali A, Hadrawi M, Almehmadi W. Painless Orbital Bone Infarction in a Child with Sickle Cell Anemia: A Case of Misdiagnosed Periorbital Cellulitis. Am J Case Rep 2023; 24:e939595. [PMID: 37917573 PMCID: PMC10626592 DOI: 10.12659/ajcr.939595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/25/2023] [Accepted: 08/23/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Sickle cell orbitopathy is a rare complication of sickle cell disease that closely mimics other conditions, such as orbital cellulitis and osteomyelitis. We report a case of painless orbital bone infarction masquerading as periorbital cellulitis in a child with sickle cell anemia. CASE REPORT A 4-year-old Saudi girl with sickle cell disease presented to our hospital with vaso-occlusive crisis characterized by bilateral lower limb pain and painless left orbital swelling. On examination, she had swelling of the left upper eyelid with redness and mild ptosis (margin reflex distance 1 was 2 mm) without proptosis. Magnetic resonance imaging with contrast showed bilateral sub-periosteal heterogeneous collections (2×0.8×2.1 cm in the superolateral wall of the left orbit and 1×0.6 cm in the inferolateral wall of the right orbit), with intermediate-to-high T1 signal intensity and high T2 signal, causing a mass effect on the adjacent superior and lateral rectus muscles. The patient was treated with systemic antibiotics and supportive treatment for vaso-occlusive crisis under the care of the pediatric team and was discharged without complications. CONCLUSIONS The diagnosis of sickle cell orbitopathy can be challenging, and an accurate diagnosis is essential to ensure appropriate management. Thus, we report the case of a 4-year-old child with painless sickle cell orbitopathy masquerading as pre-septal cellulitis.
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Affiliation(s)
- Khalid Alsaggaf
- Ophthalmology Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hazem Aljuhani
- Department of Ophthalmology, Jeddah Eye Hospital, Jeddah, Saudi Arabia
| | - Abeer Aljahdali
- Ophthalmology Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Manal Hadrawi
- Department of Ophthalmology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Wasayf Almehmadi
- Department of Ophthalmology, Jeddah Eye Hospital, Jeddah, Saudi Arabia
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Albano de Guimarães J, Boasquevisque GS, Cruz AAVE. Optic Nerve Ischemia Secondary to Pediatric Orbital Cellulitis. Ophthalmic Plast Reconstr Surg 2023; 39:e212. [PMID: 37133383 DOI: 10.1097/iop.0000000000002390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Wladis EJ, Tomlinson LA, Moorjani S, Rothschild MI. Serologic Evaluations in the Distinction Between Sinusitis-Related Orbital Cellulitis and Periorbital Necrotizing Fasciitis. Ophthalmic Plast Reconstr Surg 2023; 39:599-601. [PMID: 37338341 DOI: 10.1097/iop.0000000000002437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
PURPOSE While sinusitis-related orbital cellulitis (SROC) and periorbital necrotizing fasciitis (PNF) share similar clinical presentations, they are managed differently, making rapid recognition of the appropriate clinical entity critical to optimal outcomes. This study was performed to assess whether serologic testing might help clinicians to distinguish between SROC and PNF. METHODS A retrospective review analysis was used to compare initial complete blood counts and comprehensive metabolic panels among adult patients with SROC and PNF. Statistical evaluations were used to determine the significance of differences between the groups. RESULTS Thirteen patients with PNF and 14 patients with SROC were identified. The 2 groups were similar in age, gender, and likelihood of immunosuppression ( p > 0.05 for each metric). Mean leukocyte counts were 18.52 (standard deviation = 7.02) and 10.31 (standard deviation = 5.77) for PNF and SROC, respectively ( p = 0.0057). White blood cell levels were above normal limits for 12 patients with PNF (92.3%) and 7 patients with SROC (50%) ( p = 0.017). No other laboratory test was significantly different between the 2 groups. CONCLUSIONS While the majority of serologic testing was quite similar in patients with either SROC or PNF, leukocyte levels may represent an important clue to distinguish between the two diseases. Clinical evaluation remains the gold standard to make the proper diagnosis, but markedly elevated white blood cell counts should prompt clinicians to at least consider a diagnosis of PNF.
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Affiliation(s)
- Edward J Wladis
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Slingerlands, New York, U.S.A
- Department of Otolaryngology, Albany Medical College, Slingerlands, New York, U.S.A
| | - Lauren A Tomlinson
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Slingerlands, New York, U.S.A
| | - Smriti Moorjani
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Slingerlands, New York, U.S.A
| | - Michael I Rothschild
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Slingerlands, New York, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Liu X, Luo W, Ren W. Case Report: Vision Loss in a Child Caused by Streptococcus constellatus. Optom Vis Sci 2023; 100:721-725. [PMID: 37639550 PMCID: PMC10662613 DOI: 10.1097/opx.0000000000002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 07/30/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE We present a rare case of Streptococcus constellatus -induced odontogenic orbital cellulitis. METHODS An 8-year-old boy presented to an outpatient clinic with complaints of right-sided toothache, right eye swelling, and decreased visual acuity. He was referred to a pediatric critical care department for further management. Comprehensive diagnostic assessments, such as ophthalmic examination, blood tests, computed tomography, and MRI, were performed. RESULTS On presentation, the best-corrected visual acuities were 20/250 and 20/20 in the right and left eyes, respectively. Examination revealed grade 2+ eyelid edema and erythema and grade 4+ chemosis and exophthalmos in the right eye. The patient displayed restricted eye movements in all directions. Blood tests revealed a total white blood cell count of 12,100 cells/μL. Axial and coronal computed tomography revealed right-sided maxillary sinus, ethmoidal sinus, and orbital abscesses. Therefore, the patient was diagnosed with septicemia, orbital cellulitis, and orbital apex syndrome in the right eye. Intravenous antibiotics were administered; paracentesis of the orbital abscess was performed under local anesthesia. However, the patient's condition worsened, resulting in a complete loss of light perception in the right eye. Accordingly, surgery was performed under general anesthesia within 24 hours of admission; the surgery involved drainage of the orbital abscess through an inferior intraorbital incision, as well as drainage of the ethmoid sinus and maxillary sinus abscesses via nasal endoscopy. A culture obtained from the orbital abscess yielded S. constellatus . The infection was managed by a combination of surgical intervention, antibiotics, steroids, and hyperbaric oxygen therapy. However, because of optic nerve injury, vision in the affected eye partially recovered to 20/200. CONCLUSIONS Streptococcus constellatus -induced pediatric orbital cellulitis can result in significant morbidity. The significant improvement in vision, from no light perception to 20/200, emphasizes the importance of timely diagnosis and treatment in patients who present with acute orbital cellulitis and vision loss symptoms.
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Affiliation(s)
- Xiaoyan Liu
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Wenjuan Luo
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Wanna Ren
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
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Anselmo-Lima WT, Soares MR, Fonseca JP, Garcia DM, Velasco E Cruz AA, Tamashiro E, Valera FCP. Revisiting the orbital complications of acute rhinosinusitis. Braz J Otorhinolaryngol 2023; 89:101316. [PMID: 37678009 PMCID: PMC10495636 DOI: 10.1016/j.bjorl.2023.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE The present study revisited three classification systems of orbital complications of acute rhinosinusitis (ARS) (Chandler, Mortimore & Wormald, and Velasco e Cruz & Anselmo-Lima) and observed which of them presented the best clinical applicability. METHODS Clinical data and CT scan findings of patients with orbital infection were retrospectively collected. To compare the three classification systems, we revised and graded all CT images accordingly, and divided the patients into four groups: Eyelid cellulitis (EC), orbital cellulitis (OC), subperiosteal abscess (SA), and orbital abscess (OA). The groups were compared regarding the presence of sinus opacification, the need for hospitalization and/or surgical treatment, and the presence of further complications/sequelae. RESULTS 143 patients were included. The median number of sinuses involved in patients in the OC, SA, and OA groups was 2.0. ARS was rarely associated with signs of EC (present in both Chandler's and Mortimore & Wormald's classifications. The hospitalization rate was significantly lower in the EC group compared to the other three groups. Surgery was performed in all cases in the OA group, in 58.1% in the SA group, 19.4% in the OC group, and 12.5% in the EC group (p-value < 0.0001). Complications were present at higher rates in the OA group compared to the other three groups. CONCLUSIONS ARS was rarely associated with Eyelid Cellulitis. The stratification in the other three groups showed to be clinically relevant. Velasco e Cruz & Anselmo-Lima's classification system proved valid, simple, and effective for categorizing orbital complications of ARS. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Wilma T Anselmo-Lima
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Mateus R Soares
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Jefferson P Fonseca
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Denny M Garcia
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Antonio A Velasco E Cruz
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Edwin Tamashiro
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Fabiana C P Valera
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Divisão de Otorrinolaringologia do Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil.
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15
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Wladis EJ, Narravula R, Foyt AK, Pauze DR. Impact of Season on Incidence of Sinusitis-related Orbital Cellulitis. Ophthalmic Plast Reconstr Surg 2023; 39:458-460. [PMID: 36893065 DOI: 10.1097/iop.0000000000002362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE To explore the impact of season on the incidence of presentation to emergency departments with sinusitis-related orbital cellulitis in the United States. METHODS The National Emergency Department Sample was queried to identify cases of patients with sinusitis-related orbital cellulitis. Patient's age, location, and the month of presentation were recorded. Statistical correlations were analyzed via a dedicated software package. RESULTS A total of 439 patients with sinusitis-related orbital cellulitis were identified. The overall incidence was higher during the winter months ( p < 0.05); while children were more likely to develop this disease during the winter ( p < 0.05), season was not statistically correlated with its incidence among adults ( p = 0.16). The incidence of orbital cellulitis was higher during the winter in the midwest and south regions of the United States ( p < 0.05 for each region), although this correlation did not apply in the northeast and west ( p = 0.60 and 0.99, respectively). CONCLUSIONS While sinusitis incidence increases during the winter, the relationship between season and orbital cellulitis is complex and varies by age and geographic location. These findings may help to facilitate screening protocols for this disease and to define staffing issues for emergent ophthalmic care.
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Affiliation(s)
- Edward J Wladis
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Lions Eye Institute
- Department of Otolaryngology
| | - Raghav Narravula
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Lions Eye Institute
| | - Alexander K Foyt
- Ophthalmic Plastic Surgery, Department of Ophthalmology, Lions Eye Institute
| | - Denis R Pauze
- Department of Emergency Medicine, Albany Medical College, Slingerlands, New York, U.S.A
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Chen X, Man X, Dong L, Luan J, Li Y, Song X. Central Retinal Artery Occlusion Due to Subperiosteal Orbital Abscess Caused by Acute Sinusitis in a Child: A Case Report. Ear Nose Throat J 2023; 102:NP379-NP382. [PMID: 33975449 DOI: 10.1177/01455613211016731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Central retinal artery occlusion (CRAO) is an ophthalmic emergency and has poor visual prognosis. It is commonly found in elderly people and very rare in child. We reported an 8-year-old girl who suffered from acute sinusitis, periorbital swelling, and the visual acuity of her right eye was only light perception. She was diagnosed with CRAO, SPOA (subperiosteal orbital abscess), and acute sinusitis. Emergency treatments including surgery, antibiotics, glucocorticoids, intraocular-pressure-lowering drugs, and vasodilators were taken immediately in order to save the eyesight. The visual acuity of the right eye returned to 20/400. Conclusions: Severe intraorbital complications of acute sinusitis can lead to CRAO. Timely drainage, strong antibiotics, and glucocorticoids are the most effective methods for the treatments.
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Affiliation(s)
- Xiumei Chen
- Department of Otolaryngology Head and Neck Surgery, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong Province, China
| | - Xuejing Man
- Department of Ophthalmology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong Province, China
| | - Lei Dong
- Department of Otolaryngology Head and Neck Surgery, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong Province, China
| | - Jiangang Luan
- Department of Otolaryngology Head and Neck Surgery, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong Province, China
| | - Yuanbin Li
- Department of Ophthalmology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong Province, China
| | - Xicheng Song
- Department of Otolaryngology Head and Neck Surgery, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong Province, China
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17
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Yadalla D, Jayagayathri R, Padmanaban K, Ramasamy R, Rammohan R, Nisar SP, Rangarajan V, Menon V. Bacterial orbital cellulitis - A review. Indian J Ophthalmol 2023; 71:2687-2693. [PMID: 37417106 PMCID: PMC10491050 DOI: 10.4103/ijo.ijo_3283_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/26/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023] Open
Abstract
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.
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Affiliation(s)
- Dayakar Yadalla
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Pondicherry, India
| | | | | | - Rajkumar Ramasamy
- Department of Radiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Ram Rammohan
- Department of Microbiologist, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Sonam Poonam Nisar
- Department of Orbit, Oculoplasty, Aesthetic and Reconstructive Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Viji Rangarajan
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Vikas Menon
- Department of Orbit and Oculoplasty, Aravind Eye Hospital, Chennai, Tamil Nadu, India
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18
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Alrajhi F, Jamjoom H, Alharbi S, Alrajhi A. Orbital bone infarction masquerading as preseptal cellulitis in a child with sickle beta-thalassaemia. BMJ Case Rep 2023; 16:e252868. [PMID: 36990650 PMCID: PMC10069518 DOI: 10.1136/bcr-2022-252868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Although several ophthalmic manifestations of sickle cell disease (SCD) are common, orbital bone infarction is rare. Orbital bones have less bone marrow creating an unlikely place to develop infarction. However, having a patient with SCD presenting with periorbital swelling should warrant imaging to rule out bone infarction. We present a case of a child with sickle beta-thalassaemia who was misdiagnosed with preseptal cellulitis in the right eye. Later upon review of the subtle signs of bone infarction in imaging, she was discovered to have orbital bone infarction.
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Affiliation(s)
- Furat Alrajhi
- Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Hanan Jamjoom
- Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Suzan Alharbi
- Ophthalmology, Jeddah Eye Hospital, Jeddah, Saudi Arabia
| | - Amir Alrajhi
- Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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19
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Rajagopal R, Navneet Toshniwal N, Koka K, Madhuravasal Krishnan J, Veluswamy S. A Rare Case of Rhizopus Oryzae Keratitis following Orbital Cellulitis in a Diabetic Patient. Ocul Immunol Inflamm 2022; 30:2065-2068. [PMID: 34524937 DOI: 10.1080/09273948.2021.1974054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Rama Rajagopal
- Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | | | - Kirthi Koka
- Medical Research Foundation, Sankara Nethralaya, Chennai, India
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20
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钟 玲, 龚 广, 张 军, 孙 序, 刘 广, 崔 华, 沈 蓓. [Diagnosis and treatment of orbital complications of acute sinusitis in 51 children]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:519-522. [PMID: 35822379 PMCID: PMC10128393 DOI: 10.13201/j.issn.2096-7993.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Indexed: 06/15/2023]
Abstract
Objective:To analyze the clinical features, diagnosis and treatment of acute sinusitis related orbital cellulitis in children. Methods:The data of 51 cases with acute sinusitis comorbid with orbital cellulitis in Tianjin Children's Hospital from April 2016 to March 2021 were retrospectively analyzed. According to the extent of infection, the patients were divided into two groups:pre-septal orbital cellulitis(7 cases) and post-septal orbital cellulitis(44 cases). The general clinical characteristics, clinical manifestations, laboratory examination and treatment were compared between the two groups. Among them, 23 cases(6 in pre-septal orbital cellulitis group and 17 in post-septal orbital cellulitis group) were cured by medicine treatment; 28 cases were cured by surgical treatment after failure of medicine treatment. Results:There was no significant difference in age, gender and medical history between the two groups. Redness, swelling, heat and pain in eyelid was the most common clinical manifestations of orbital cellulitis in children, followed by fever, headache, runny nose, eye fixation, and vision loss. WBC count and neutrophils percentage were significantly higher in post-septal orbital cellulitis group. All children were followed up for 3 months to 3 years, 1 case was lost to follow-up, 50 cases had no recurrence and recovered well. Conclusion:Orbital cellulitis is a common and rapid developing complication of sinusitis in children. Early diagnosis and effective anti-infection treatment are very important for prognosis. Orbital CT plays an important role in the determination and evaluation of this complication. When conservative treatment is ineffective, surgical drainage in time can reduce the occurrence of serious ocular sequelae.
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Affiliation(s)
- 玲玲 钟
- 天津大学儿童医院 天津市儿童医院耳鼻咽喉头颈外科(天津,300074)Department of Otolayngology Head and Neck Surgery, Tianjin University Children's Hospital, Tianjin Children's Hospital, Tianjin, 300074, China
| | - 广港 龚
- 天津大学儿童医院 天津市儿童医院耳鼻咽喉头颈外科(天津,300074)Department of Otolayngology Head and Neck Surgery, Tianjin University Children's Hospital, Tianjin Children's Hospital, Tianjin, 300074, China
| | - 军梅 张
- 天津大学儿童医院 天津市儿童医院耳鼻咽喉头颈外科(天津,300074)Department of Otolayngology Head and Neck Surgery, Tianjin University Children's Hospital, Tianjin Children's Hospital, Tianjin, 300074, China
| | - 序元 孙
- 天津大学儿童医院 天津市儿童医院耳鼻咽喉头颈外科(天津,300074)Department of Otolayngology Head and Neck Surgery, Tianjin University Children's Hospital, Tianjin Children's Hospital, Tianjin, 300074, China
| | - 广平 刘
- 天津大学儿童医院 天津市儿童医院耳鼻咽喉头颈外科(天津,300074)Department of Otolayngology Head and Neck Surgery, Tianjin University Children's Hospital, Tianjin Children's Hospital, Tianjin, 300074, China
| | - 华雷 崔
- 天津大学儿童医院 天津市儿童医院普外科Department of General Surgical, Tianjin University Children's Hospital, Tianjin Children's Hospital
| | - 蓓 沈
- 天津大学儿童医院 天津市儿童医院耳鼻咽喉头颈外科(天津,300074)Department of Otolayngology Head and Neck Surgery, Tianjin University Children's Hospital, Tianjin Children's Hospital, Tianjin, 300074, China
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21
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Ray H, Megalla M, Linderman W, Habib L. Septic Superior Ophthalmic Vein Thrombosis in a Prothrombotic Adolescent Patient. Ophthalmic Plast Reconstr Surg 2022; 38:e57-e59. [PMID: 34812180 DOI: 10.1097/iop.0000000000002097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 14-year-old boy presented to the emergency room with 5 days of fever and periorbital edema and erythema refractory to 4 days of augmentin and clindamycin. Examination revealed normal visual acuity, mild left periorbital edema and erythema, and a (-)1 supraduction deficit, concerning for orbital cellulitis. CT imaging revealed pansinusitis, orbital cellulitis with subtle orbital fat stranding, and a dilated superior ophthalmic vein with concern for thrombosis. This was confirmed on subsequent magnetic resonance venography. He was treated with intravenous antibiotics and enoxaparin with significant improvement in 24 hours. Standard hypercoagulable workup revealed positive lupus anticoagulant and cardiolipin of unclear significance; on genetic sequencing, he was found to have a homozygous mutation of the 4G variant of plasminogen activator inhibitor-1. Plasminogen activator inhibitor-1 homozygosity is a rare predisposing hypercoagulable state. This case highlights the importance of hematologic and genetic studies in adolescent patients with superior ophthalmic vein thrombosis, particularly those with mild presentation.
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Affiliation(s)
- Hetal Ray
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, U.S.A
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22
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吕 萍, 宋 伟, 李 丹. [Treatment strategy of nasal orbital complications in children]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:135-138. [PMID: 35172552 PMCID: PMC10128315 DOI: 10.13201/j.issn.2096-7993.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Indexed: 06/14/2023]
Abstract
Objective:The aim of this study is to explore the treatment strategy of children's nasal orbital complications. Methods:The clinical data of 28 children with nasal orbital complications admitted to Dalian Children's Hospital from February 2018 to February 2021 were analyzed and summarized. Results:Among the 28 children, 18 were males (64.3%), 10 females (35.7%), 16 cases of orbital cellulitis, 10 cases of orbital subperiosteal abscess, 1 case of intraorbital abscess, and 1 case of cavernous sinus thrombophlebitis. Of the children with orbital cellulitis, 2 cases were treated with surgery, 4 cases with orbital subperiosteal abscess were treated with surgery, and the children with intraorbital abscess and cavernous sinus thrombophlebitis were treated with surgery. All the children were cured, and the clinical follow-up was more than half a year. No recurrence occurred. Conclusion:Periorbital cellulitis is the most common type of orbital complications. After conservative treatment (3-7 days), most children can get good results. Once the visual acuity is progressively decreased, the infection becomes worse, the eyeball movement disorder and other symptoms occur at this time, surgical treatment should be actively considered, and the timing of surgery is very important for the prognosis.
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Affiliation(s)
- 萍 吕
- 大连市妇女儿童医疗中心(集团)耳鼻咽喉科(辽宁大连,116012)Dalian Women and Children's Medical Center[Group], Dalian, 116012, China
| | - 伟 宋
- 大连市妇女儿童医疗中心(集团)耳鼻咽喉科(辽宁大连,116012)Dalian Women and Children's Medical Center[Group], Dalian, 116012, China
| | - 丹丹 李
- 大连市妇女儿童医疗中心(集团)耳鼻咽喉科(辽宁大连,116012)Dalian Women and Children's Medical Center[Group], Dalian, 116012, China
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23
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Sheils CR, Cypen SG, Tao JP. Blindness Secondary to Odontogenic Orbital Cellulitis During the COVID-19 Dental Shutdown. Ophthalmic Plast Reconstr Surg 2021; 37:e194. [PMID: 34269769 PMCID: PMC8425511 DOI: 10.1097/iop.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Catherine R. Sheils
- Gavin Herbert Eye Institute; University of California, Irvine, California, U.S.A
| | - Sanja G. Cypen
- Gavin Herbert Eye Institute; University of California, Irvine, California, U.S.A
| | - Jeremiah P. Tao
- Gavin Herbert Eye Institute; University of California, Irvine, California, U.S.A
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24
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Hernandez-Bogantes E, Wu L. Reply re: "Orbital Cellulitis in Chagas Disease: An Unusual Presentation". Ophthalmic Plast Reconstr Surg 2021; 37:500-501. [PMID: 34524251 DOI: 10.1097/iop.0000000000002041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Erick Hernandez-Bogantes
- Ocular Center, Heredia
- Macula, Vitreous and Retina Associates of Costa Rica, San Jose, Costa Rica
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San Jose, Costa Rica
- Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois, U.S.A
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25
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Madan S, Beri S, Virmani P, Khan S, Chakravarti A. Bilateral orbital cellulitis in an infant: An unusual case. Natl Med J India 2021; 34:213-215. [PMID: 35112546 DOI: 10.25259/nmji_555_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bilateral orbital cellulitis is an uncommon presentation in infants, and its association with rhinosinusitis has been scantily reported in the literature. An infant underwent bilateral uncinectomy and right ethmoidal decompression for bilateral orbital cellulitis with right ethmoidal sinusitis, after a period of non-recovery with conservative treatment. Mixed infection with Escherichia coli and methicillin-sensitive Staphylococcus aureus was observed. The right eyelid swelling began to resolve; however, the left lower eyelid showed an increase in the fluctuant swelling. Transconjunctival incision and drainage of pus was done in the left eye subsequently. The patient showed marked clinical recovery and is doing well. A multidisciplinary management approach can avert potentially life-threatening sequelae of this condition.
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Affiliation(s)
- Siddharth Madan
- Department of Ophthalmology, University College of Medical Sciences, Dilshad Garden, Delhi 110095, India
| | - Sarita Beri
- Department of Ophthalmology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, Delhi, India
| | - Prachi Virmani
- Department of Ophthalmology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, Delhi, India
| | - Sarah Khan
- Department of Ophthalmology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, Delhi, India
| | - Arunabha Chakravarti
- Department of Otorhinolaryngology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, Delhi, India
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Chauhan K, Sabarwal S, Soni D, Karkhur S. Silicone oil-associated orbital cellulitis with lipogranulomatous inflammation in the setting of HIV: a management challenge and clinicopathological correlation. BMJ Case Rep 2021; 14:e239118. [PMID: 33687937 PMCID: PMC7944979 DOI: 10.1136/bcr-2020-239118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/04/2022] Open
Abstract
A 58-year-old Indian man presented with pain and redness of the left eye (OS) for one day. Patient had undergone silicone oil removal in OS for emulsified oil following vitrectomy and oil tamponade six months ago when he was diagnosed with retinal detachment in both eyes due to HIV retinopathy. Retinal detachment in the right eye (OD) was inoperable and had turned prephthisical at presentation, while his vision in OS was finger counting. Intraocular pressure in OD was 8 mm Hg and unrecordably elevated in OS. Extraocular movements were limited by periorbital oedema and proptosis. Slit-lamp examination revealed corneal haze, cells 2+/flare 1+ with pseudophakia, and attached retina. Histopathology showed lipogranulomatous inflammation, hitherto unreported in association with silicone oil. The index case posed a management challenge since his only functional eye had potentially been compromised by glaucoma and orbital cellulitis with compartment syndrome, against the backdrop of an immunocompromised status.
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Affiliation(s)
- Khushboo Chauhan
- Department of Ophthalmology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Sunita Sabarwal
- Department of Ophthalmology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
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Turbin RE, Wawrzusin PJ, Sakla NM, Traba CM, Wong KG, Mirani N, Eloy JA, Nimchinsky EA. Orbital cellulitis, sinusitis and intracranial abnormalities in two adolescents with COVID-19. Orbit 2020; 39:305-310. [PMID: 32419568 DOI: 10.1080/01676830.2020.1768560] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/09/2020] [Indexed: 06/11/2023]
Abstract
We review two cases of adolescents with orbital cellulitis, sinusitis and SARS- CoV-2 infection presenting to emergency departments within a 24 hour period. SARS-CoV-2 samples obtained within 24 hours were positive, supporting prior infection despite relatively limited early symptoms of COVID-19. Unusual clinical and radiographic characteristics included hemorrhagic abscess with blood of varying age in the first, intracranial epidural abscess in the second, radiographic signal consistent with hemorrhagic or thrombotic phenomena, retro-maxillary antral fat changes, and meningeal enhancement or extension in both cases. Radiographic findings thereby mimic fungal infection, although final cultures and ancillary investigation for allergic and invasive fungal disease have remained negative. These cases highlight two unusual orbital presentations of cellulitis occurring in the context of SARS-CoV-2 co-infection.
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Affiliation(s)
- Roger E Turbin
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School , Newark, New Jersey, USA
| | - Peter J Wawrzusin
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School , Newark, New Jersey, USA
| | - Nicole M Sakla
- Department of Radiology, Newark Beth Israel Medical Center , Newark, New Jersey, USA
| | - Christin M Traba
- Department of Pediatrics, Rutgers New Jersey Medical School , Newark, New Jersey, USA
| | - Kristin G Wong
- Department of Medicine, Rutgers New Jersey Medical School , Newark, New Jersey, USA
| | - Neena Mirani
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School , Newark, New Jersey, USA
| | - Jean A Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School , Newark, New Jersey, USA
| | - Esther A Nimchinsky
- Department of Radiology, Rutgers New Jersey Medical School , Newark, New Jersey, USA
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Bačová E, Chovanec F, Makohusová M, Hederová S, Mikesková M, Hrašková A, Rudinský B, Plank L, Volfová P, Kolenová A. Invasive Rhino-Orbito-Cerebral Mucormycosis in Pediatric Patient with Acute Leukemia. Klin Onkol 2020; 33:138-144. [PMID: 32303134 DOI: 10.14735/amko2020138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Invasive fungal infections are a life-threatening complication of cancer treatments, especially in hemato-oncological patients. Mucormycosis is the third leading cause of invasive fungal infections after Aspergillus and Candida infections. The first clinical symptoms are usually non-specific, which can lead to a late diagnosis and delayed therapy. PURPOSE The objective of this report is to summarize data in the literature about mucormycosis and to present a case report of a patient with acute lymphoblastic leukemia, who developed this infection at our center. Risk factors for the development of mucormycosis, clinical symptoms, radiology, laboratory results, and outcome were retrospectively evaluated. CASE We describe a 6-years-old female patient with acute lymphoblastic leukemia. During the induction phase of therapy, the patient developed febrile neutropenia and did not respond to therapy with a combination of antibiotics and supportive treatment. Pansinusitis and orbitocellulitis developed. Examination of the biological material revealed that the etiological agent was a Rhizopus sp. The patient was treated with a combination of antimycotic drugs, but the infection disseminated to the central nervous system. She underwent radical surgical resection of the affected tissue. At this time, she is still under treatment with antimycotic and oncology agents, but is in remission of the main diagnosis and in good clinical condition. CONCLUSION Mucormycosis is an invasive fungal infection with high morbidity and mortality. Early diagnosis and initiation of effective therapy using a combination of amphotericin B administration and surgery are necessary to obtain a favorable outcome. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.
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van der Poel NA, van der Veer EG, Ebbens FA, de Win MM, Kloos RJ, Mourits MP. [Diagnosis and treatment of orbital cellulitis]. Ned Tijdschr Geneeskd 2017; 161:D1342. [PMID: 28745248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Orbital cellulitis is a rare disease usually caused by sinusitis. Generally, the prognosis of both preseptal cellulitis and orbital cellulitis is favourable. Radiological distinction should be made between an orbital abscess and subperiosteal empyema. Theoretically, empyema is more accessible to antibiotics and, as it arises in a pre-existing anatomical space, it needs less aggressive treatment than an abscess. In contrast, the wall of an abscess created by the bacteria is scarcely permeable to antibiotics. Indications for surgical drainage should be based on clinical findings and not on Chandler's classification. Loss of vision, an unresponsive pupil or a densely packed orbit are indications for immediate surgical drainage. Drainage of an orbital abscess may speed up recovery.
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Abstract
Periorbital cellulitis is a relatively common ocular disease in the pediatric population. Early diagnosis of this disease with a prompt intervention is critical to avoid vision and life-threatening complications. In the last years, medical therapy has been expanding for the treatment of orbital cellulitis, instead of the standard surgical approach. The purpose of this study was to describe the outcome of treatment with intravenous antibiotic of periorbital cellulitis in children. A retrospective review of all children admitted with periorbital cellulitis in our hospital between January 2002 and July 2013 was conducted. Cases were divided in two subgroups, pre-septal and post-septal infection. The demographics, clinical findings, treatment and outcomes were analyzed. In total 110 children were included, 93 with pre-septal and 17 with post-septal cellulitis. The mean age was 3.5 years in children with pre-septal cellulitis and 5.5 years in those with post-septal cellulitis (p = 0.149). For both subgroups the most common predisposing factor was sinusitis. Intravenous antibiotic therapy was successful in all except one patient with an orbital abscess who required surgical intervention. In our study complete recovery was achieve in all (except for one) children with periorbital cellulitis treated with intravenous antibiotics only.
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Affiliation(s)
- Rita Gonçalves
- a Department of Ophthalmology , Pedro Hispano Hospital , Matosinhos , Portugal
| | - Carlos Menezes
- a Department of Ophthalmology , Pedro Hispano Hospital , Matosinhos , Portugal
| | - Rute Machado
- b Department of Pediatrics , Pedro Hispano Hospital , Matosinhos , Portugal
| | - Isabel Ribeiro
- a Department of Ophthalmology , Pedro Hispano Hospital , Matosinhos , Portugal
| | - José A Lemos
- a Department of Ophthalmology , Pedro Hispano Hospital , Matosinhos , Portugal
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Abstract
OBJECTIVES The study aimed to investigate the clinical characteristics, diagnosis, and treatment of orbital cellulitis in children in Shenzhen, China, and to improve the experience of antibiotic therapy for the treatment of orbital cellulites. METHODS This retrospective study reviewed data from 20 children admitted to Shenzhen Children's Hospital between January 2009 and December 2013, with a diagnosis of nasal orbital cellulitis, severe enough to warrant hospitalization. Thirteen subjects (65%) were male and 7 (35%) were female. The median age was 3.5 years (2 months-7.2 years). The relationship between serum C-reactive protein (CRP), white blood cell count, and length of hospitalization were analyzed. The patients were categorized into 2 groups according to treatment: Those treated with a combination of cefoperazone plus sulbactam sodium vs. those treated with other antibiotic treatment regimens. RESULTS Levels of serum CRP (29.8 ± 22.0 mg/L) at the time of admission were positively correlated with length of hospitalization (6.3 ± 4.1 days, r = 0.46, P < 0.05). The length of time necessary for CRP levels to return to normal range after admission (3.4 ± 1.8 days) was also significantly correlated length of hospitalization ((6.3 ± 4.1)days) (r = 0.81, P < 0.01). The hospital days whose CRP can be decreased to normal within 3 days (4.3 ± 1.7 days) after antibiotic treatment were significantly shorter than the others (9.1 ± 5 days) (t = 2.61, P < 0.05). The length of hospitalization (4.3 ± 1.9 days) for patients (n = 12) receiving combined cefoperazone and sulbactam sodium antibiotic treatment was significantly shorter than the length of stay (9.3 ± 4.7 days) for those patients (n = 8) treated with other antibiotic regimens (t = 2.83, P < 0.05). Bacterial pathogens were identified in 4 patients (20%), including 3 cases of Staphylococcus aureus and 1 case of Streptococcus anginosus. Acquired methicillin-resistant Staphylococcus aureus (MRSA) were found in the three pus cultures. CONCLUSION Early efficient antibiotic treatment over the first three days may shorten the course of nasal orbital cellulitis and potentially prevent the formation of orbital abscesses. Clinical factors that were significantly related to patient recovery included improved clinical signs and normalization of blood CRP levels. Our results also indicate that combined cefoperazone and sulbactam sodium is effective and should be recommended for the treatment of pediatric orbital cellulitis.
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Affiliation(s)
- Pan Hongguang
- Department of Otolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
| | - Li Lan
- Department of Otolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Wu Zebin
- Department of Otolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Chen Guowei
- Department of Otolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
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Trnavec B, Vodrazkova E, Cernak A. Orbital phlegmona from upper eyelid chalazion. BRATISL MED J 2016; 117:299. [PMID: 27215967 DOI: 10.4149/bll_2016_059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Odontogenic orbital cellulitis, although uncommon, has the potential to cause severe vision loss if unsuspected and untreated. Compared to non-odontogenic bacteriology, odontogenic orbital abscesses typically feature a heavy mixed growth with anaerobic organisms. We review the literature and discuss the case of a 26-year-old male who presented with anaerobic orbital cellulitis for treatment.
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Affiliation(s)
- William Yan
- Faculty of Medicine, Nursing, Health Sciences, Monash University , Clayton , Australia and
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Affiliation(s)
- Mark S Harris
- Northampton General Hospital, Northampton NN1 5BD, UK
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Šuchaň M, Horňák M, Kaliarik L, Krempaská S, Koštialová T, Kovaľ J. [Orbital complications of sinusitis]. Cesk Slov Oftalmol 2014; 70:234-238. [PMID: 25640234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Orbital complications categorised by Chandler are emergency. They need early diagnosis and agresive treatment. Stage and origin of orbital complications are identified by rhinoendoscopy, ophtalmologic examination and CT of orbite and paranasal sinuses. Periorbital cellulitis and early stage of orbital cellulitis can be treated conservatively with i. v. antibiotics. Monitoring of laboratory parameters and ophtalmologic symptoms is mandatory. Lack of improvement or worsening of symptoms within 24-48 hours and advanced stages of orbital complications are indicated for surgery. The purpose of the study is to evaluate epidemiology, clinical features and management of sinogenic orbital complications. Retrospective data of 8 patients with suspicion of orbital complication admited to hospital from 2008 to 2013 were evaluated. Patients were analyzed in terms of gender, age, CT findings, microbiology, clinical features, stage and treatment. Male and female were afected in rate 1,66:1. Most of patients were young adult in 3rd. and 4th. decade of life (62,5 %). Acute and chronic sinusitis were cause of orbital complication in the same rate. The most common origin of orbital complication was ethmoiditis (62,5 %), than maxillary (25 %) and frontal (12,5 %) sinusitis. Polysinusitis with affection of ethmoidal, maxillary and frontal sinuses (75 %) was usual CT finding. Staphylococcus epidermidis and Staphylococcus aureus were etiological agens in half of cases. Periorbital oedema (100 %), proptosis, chemosis (50 %), diplopia and glaucoma (12,5 %) were observed. Based on examinations, diagnosis of periorbital oedema/preseptal cellulitis was made in 3 (37,5 %), orbital cellulitis in 3 (37,5 %) and subperiosteal abscess in 2 cases (25 %). All patients underwent combined therapy - i. v. antibiotics and surgery within 24 hours. Eradication of disease from ostiomeatal complex (OMC), drainage of affected sinuses and drainage of subperiosteal abscess were done via fuctional endonasal endoscopic surgery (FEES). In case of superior subperiosteal abscess, combined endonasal and external approach (external orbitotomy) was needed. Combined therapy facilitated quick improvement of local and systematic symptoms. Average time of hospitalisation was 7 days. Early diagnosis and agresive combined therapy prevent loss of vision and life threatening complications.
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Abstract
BACKGROUND Orbitocranial complications (OCCs) of sinusitis are uncommon but potentially life threatening. OCCs carry high morbidity, mortality, and significant long-term sequelae. Late recognition leads to even worse outcomes. OBJECTIVE To present four case reports showing that aggressive management of complications of sinusitis-like OCC decreases long-term sequelae and mortality in pediatric patients. CASE REPORTS Four pediatric patients diagnosed with OCC were treated at our institution from April 2012 to March 2013. Three were boys and one was a girl; ages ranged from 4-14 years. Magnetic resonance imaging and computed tomography were the most useful imaging modalities. All patients received broad-spectrum antibiotics. Additional interventions consisted of endoscopic sinus surgery, subdural empyema drainage, and orbital decompression. CONCLUSION The difficult complications of acute sinusitis in the pediatric age group should be anticipated, recognized early, and aggressively managed to prevent morbidity and a fatal outcome.
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Affiliation(s)
- Pradeep Kumar Sharma
- Pediatric Intensive Care Unit, B L Kapur Super Specialty Hospital, New Delhi, India
| | - Bhaskar Saikia
- Pediatric Intensive Care Unit, B L Kapur Super Specialty Hospital, New Delhi, India
| | - Rachna Sharma
- Pediatric Intensive Care Unit, B L Kapur Super Specialty Hospital, New Delhi, India
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Promelle V, Bennai D, Drimbea A, Milazzo S, Bremond-Gignac D. Cellulites orbitaires atypiques d’origine non sinusienne de l’enfant : à propos de quatre cas. J Fr Ophtalmol 2014; 37:149-54. [PMID: 24239218 DOI: 10.1016/j.jfo.2013.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/26/2013] [Accepted: 08/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
- V Promelle
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France.
| | - D Bennai
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
| | - A Drimbea
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
| | - S Milazzo
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
| | - D Bremond-Gignac
- Centre d'ophtalmologie Saint-Victor, CHU d'Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France
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Mottard N, Cour M, Robert D, Argaud L. Facial cellulitis secondary to chronic non-invasive ventilation. Intensive Care Med 2013; 40:105-6. [PMID: 24081435 DOI: 10.1007/s00134-013-3114-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/13/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Nicolas Mottard
- Service de Réanimation Médicale, Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, 69003, Lyon, France
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Muzzi E, Parentin F, Pelos G, Grasso DL, Lora L, Trabalzini F, Pensiero S, Orzan E. Bilateral orbital preseptal cellulitis after combined adenotonsillectomy and strabismus surgery--case report and pathogenetic hypothesis. Int J Pediatr Otorhinolaryngol 2013; 77:1209-11. [PMID: 23664368 DOI: 10.1016/j.ijporl.2013.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 04/06/2013] [Accepted: 04/09/2013] [Indexed: 11/18/2022]
Abstract
The first case of bilateral orbital preseptal cellulitis complicating combined adenotonsillectomy and strabismus surgery is reported. The issues of antimicrobial prophylaxis are discussed. The authors speculate about the possible routes of surgical site infection. Transient bacteraemia secondary to adenotonsillectomy may be theoretically a source of distant surgical site infection to the orbit, raising the issue of distant surgical site contamination during multidisciplinary surgery. Combined adenotonsillectomy and eye surgery might benefit from prophylactic systemic antibiotic administration.
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Affiliation(s)
- E Muzzi
- Audiology and ENT Unit, Department of Pediatrics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy.
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De Melo WM, Sonoda CK, Hochuli-Vieira E, Gabrielli MAC, Gabrielli MFR. Paranasal sinus infection causing orbital subperiosteal abscess: surgical management of this devastating entity. Oral Maxillofac Surg 2013; 17:131-135. [PMID: 22847036 DOI: 10.1007/s10006-012-0343-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 07/16/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Orbital infection is an uncommon devastating infection and is usually a complication of paranasal sinus infection. Without appropriate treatment, orbital infection may lead to serious complications, even death. Prompt treatment is mandatory to avoid visual loss or intracranial complications. The literature shows that initially, intravenous antibiotics should be administered, and after 48 h, if no improvement appears, the affected orbit and the sinuses must be surgically drained. The authors describe two cases of orbital cellulitis with a brief literature review. CASE REPORT The authors describe two cases of orbital abscess caused by paranasal sinus infection. In case 1, the patient presented a decreased visual acuity associated with ophthalmoplegia of the right eye. In case 2, the patient presented a decreased visual acuity. Thus, administration of intravenous antibiotic combined with surgical drainage was performed. After surgical procedure, eye movements were normalized in case 1, and in both patients, the visual acuity returned to normal parameters. DISCUSSION The authors recommend early surgical drainage with parenteral antibiotic administration and careful postoperative observations by monitoring the signs and symptoms of the orbital complaint.
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Affiliation(s)
- Willian Morais De Melo
- Diagnosis &Surgery Department, Araraquara Dental School, São Paulo State University, Araraquara, São Paulo, Brazil.
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Saetang S, Preechawai P, Hirunpat S. Retrograde cavernous sinus thrombosis and orbital cellulitis secondary to meningitis in immunocompetence child. J Med Assoc Thai 2012; 95:1485-1488. [PMID: 23252217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A case of cavernous sinus thrombosis is usually a complication of severe orbital cellulitis and meningitis. The authors reported a retrograde cavernous sinus thrombosis and orbital cellulitis in an immunocompetence child, due to meningitis.
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Affiliation(s)
- Saowanit Saetang
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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Balogun BG, Balogun MM, Adekoya BJ. Orbital cellulitis: clinical course and management challenges. the Lagos State University Teaching Hospital experience. Nig Q J Hosp Med 2012; 22:231-235. [PMID: 24568055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Orbital cellulitis is a devastating acute infection of orbital soft tissues located posterior to the orbital septum. It is both vision and life-threatening. It is an ocular emergency which most often present in childhood. OBJECTIVE This article reviewed cases presenting during the study period with the view of examining the pattern of presentation, clinical course and management challenges. METHODS A retrospective study was conducted on patients presenting with orbital cellulitis between January 2008 and June 2011. Socio-demographic data, entry and discharge visual acuity, presenting complaints, predisposing factors, duration of complaints, admission period and complications were extracted from clinical records and analyzed. RESULTS Seventeen (17) patients presented with orbital cellulitis constituting 6.2% of ocular emergency admissions during the study period. Twelve (70.6%) were males. Thirteen (76.5%) were children. The major predisposing factors were upper respiratory tract infections, and facial and globe injuries in five (22.7%) cases respectively. Only five (29.4%), presented within three days of disease onset. Average duration of admission was 10.6 days. Complications during the course of disease were category 4 and 5 blindness in five (23.5%), orbital abscess four (23.5%), cavernous sinus thrombosis two (11.8%), contralateral preseptal cellulitis two (11.8%) and exposure keratopathy in one (5.9%). CONCLUSION Orbital cellulitis has remained a disease with high ocular morbidity. The major management challenges were poor financial status of patients precluding necessary diagnostic laboratory and imaging studies. Early recognition, diagnosis and treatment are crucial to the preservation of vision and reduced occurrence of complications. The importance of record keeping is also highlighted.
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Affiliation(s)
- Bolanle G Balogun
- Department of Ophthalmology, Lagos State University Teaching Hospital/College of Medicine, 1-5, Oba Akinjobi Street, GRA, Ikeja, Lagos, Nigeria.
| | - Modupe M Balogun
- Department of Ophthalmology, Lagos State University Teaching Hospital/College of Medicine, 1-5, Oba Akinjobi Street, GRA, Ikeja, Lagos, Nigeria
| | - Bola J Adekoya
- Department of Ophthalmology, Lagos State University Teaching Hospital/College of Medicine, 1-5, Oba Akinjobi Street, GRA, Ikeja, Lagos, Nigeria
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Cannon PS, Cruz AAV, Pinto CT, Mastropietro DA, Chahud F, Bilyk JR, Selva D, Prabhakaran VC. A multi-centre case series investigating the aetiology of hypertrophic pachymeningitis with orbital inflammation. Orbit 2011; 30:64-69. [PMID: 21322792 DOI: 10.3109/01676830.2010.539766] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION To describe our attempt in establishing a definitive diagnosis in patients with hypertrophic pachymeningitis in combination with orbital inflammatory disease and report on the outcome. MATERIALS AND METHODS This was a retrospective case series of all patients presenting with hypertrophic pachymeningitis in association with orbital inflammation in 4 centres. Ophthalmic and neurological examination data, laboratory data, histology data, treatment plans and clinical outcome data were recorded. Patients underwent orbital/brain computed tomography and magnetic resonance imaging. RESULTS Six patients were identified; the median age was 46.5 years. Headache was the commonest presenting symptom, followed by diplopia and reduced visual acuity. Three patients underwent orbital biopsy, 1 patient underwent dura mater biopsy, 1 patient underwent both and 1 patient underwent nasal biopsy. Four patients were diagnosed with Wegener granulomatosis and 2 patients with tuberculosis. Corticosteroid therapy was initiated in 4 patients, with steroid-sparing drugs added later. Two patients received anti-tuberculosis treatment and 1 patient was commenced on pulsed cyclophosphamide. On follow-up, 1 patient required an exenteration for a painful blind eye and 1 patient's visual acuity remained at no perception to light. One patient had complete resolution of symptoms on treatment, 1 patient had persistent reduced visual acuity and 1 patient was lost to follow-up. CONCLUSION We postulate that the combination of orbital inflammation and pachymeningitis is strongly suggestive of Wegener granulomatosis, although it may take a number of years to confirm. Tuberculosis should also be considered.
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Affiliation(s)
- Paul S Cannon
- Discipline of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, SA 5000, Australia.
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Mallis A, Mastronikolis SN, Naxakis SS, Papadas AT. Rhinocerebral mucormycosis: an update. Eur Rev Med Pharmacol Sci 2010; 14:987-992. [PMID: 21284348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Mucormycoses are a group of invasive infections caused by filamentous fungi of the Mucoraceae family, with the rhinocerebral form of the disease being the most common in large case series. In the present paper we review the characteristics of the rhinocerebral form of the disease. EVIDENCE AND INFORMATION SOURCES The present review is based on the analysis of the current literature on rhinocerebral mucormycosis. STATE OF THE ART Rhinocerebral mucormycosis is associated with immunocompromised patient state, haemochromatosis, desferrioxamine therapy and prolonged corticosteroid therapy. Uncontrolled diabetes and increased serum iron are regarded as the two leading predisposing factors for the development of the disease. Currently, treatment for the disease is based on three main principles; rapid reversal of underlying predisposing factors, antifungal therapy with amphotericin B and timely surgical intervention. PERSPECTIVES Antifungal drugs of the azole group and new iron chelating agents--deferasirox, deferiprone--have been supported as alternative options to amphotericin B or as salvage therapy. CONCLUSIONS Rhinocerebral mucormycosis requires a high level of awareness if early diagnosis and treatment is to be achieved. Large scale evaluation of arising treatment options is a mandatory course of action in the future research of the disease.
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Affiliation(s)
- A Mallis
- ENT Department, University Hospital of Patras, Greece.
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Braich PS, Bakshi A, Blankas-Hernaez N. A 22-month-old boy with eye swelling. Pediatr Ann 2010; 39:336, 339-40. [PMID: 20669887 DOI: 10.3928/00904481-20100521-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yardley AME, Sachdev N, Aburn NS. Unusual cause of presumed orbital cellulitis. Clin Exp Ophthalmol 2010; 38:321-2. [PMID: 20447132 DOI: 10.1111/j.1442-9071.2010.02243.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Akcay EK, Cagil N, Yulek F, Yuksel D, Simsek S. Congenital lacrimal sac diverticulum as a cause of recurrent orbital cellulitis. Can J Ophthalmol 2009; 44:e29-30. [PMID: 19610246 DOI: 10.3129/i09-073] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
PURPOSE Acute dacryocystitis commonly presents as preseptal cellulitis as lacrimal sac lies anterior to the orbital septum and hence infection localizes in the preseptal space. The purpose of this study is to describe presentation and management of cases of acute dacryocystitis presenting as orbital cellilitis and abscess secondary to acute dacryocystitis. METHOD This retrospective, non-comparative, interventional case series included 6 patients presenting with orbital cellulitis and abscess secondary to acute dacryocystitis. All patients underwent drainage of abscess under general anesthesia. External dcaryocystorhinostomy was advised as the definitive treatment for all pateints. RESULT Abscess was localized in the extraconal space in 4 patients and in the intraconal space in 2 patients. Patients with intraconal abscess had visual loss on presentation while vision could be preserved in patients with abscess in extraconal space. Both patients with intraconal abscess had history of acute dacryocystitis. CONCLUSION Acute dacryocystitis is an ophthalmic emergency that can cause orbital cellulitis with abscess formation, and even vision loss, if left untreated.
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Abstract
Inflammatory conditions belong to the most important diseases of the orbit. Children and adolescents are mostly affected and the most common cause is secondary pathogen invasion from acute sinusitis. However in adults most cases involve idiopathic orbital inflammation, previously termed pseudotumor orbitae. Clinical presentation may include painful exophthalmus, skin redness and warming, chemosis and disturbed eye motility. The challenge for imaging investigations, mainly a combination of CT scanning and MRI, is to distinguish inflammatory from malignant conditions, to define the extent of lesions and to document possible complications, such as cavernous sinus thrombosis, meningoencephalitis or cerebral abscesses. Serious potential consequences of orbital infections, including loss of vision or death, are still a risk factor and must be averted by avoidance of delays in diagnosis and appropriate clinical management.
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Affiliation(s)
- A Zimmer
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Strasse, 66421 Homburg.
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