DOCSLIB.ORG

Preseptal Vs. Orbital Cellulitis Welcome Dr. Alana Curatola, OD

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Preseptal Vs. Orbital Cellulitis Welcome Dr. Alana Curatola, OD March 2018 Welcome Preseptal vs. Orbital Cellulitis By Joshua Clermont, OD Dr. Alana It is not uncommon for patients to present to us Curatola, with a unilateral, red, and swollen eyelid that is OD tender to the touch. Typically, we diagnose preseptal cellulitis and prescribe a short course Alana Curatola, of oral antibiotics. However, it is critical to rule OD, joined the out orbital cellulitis. The two entities can Northwest Eye present with similar signs and symptoms (Figure Surgeons team 1). Alana Curatola, OD in December Joshua Clermont, OD 2017. She is passionate about collaborative health care and provides However, they have very pre- and postoperative care, and general different clinical implications, medical eye care in the Seattle and with orbital cellulitis potentially Renton clinics. leading to vision- and/or life- Dr. Curatola grew up in Orange County, CA threatening consequences. before relocating to the Seattle area. In Here, I will discuss the key her free time, she enjoys family time, differences between orbital hanging out with her two dogs, hiking, and preseptal cellulitis to help traveling, cooking, camping, guide clinical management. Preseptal cellulitis is a bacterial snowboarding, home decor, crafting and Figure 1: Lid chemosis and erythema that watching football on Sunday. infection that is limited to the could be preseptal or orbital cellulitis. She completed her undergraduate studies eyelid or, as the name implies, in kinesiology at California Polytechnic anterior to the orbital septum (Figure 2). Orbital cellulitis is an infection that University - San Luis Obispo, and her OD extends posterior to the septum, affects orbital fat and muscle with the at Southern California College of possibility of associated abscess extending to the orbital apex. Preseptal Optometry at Marshall B. Ketchum cellulitis is far more common than orbital cellulitis and both infections University, Fullerton. occur more often in young children than adults. Her optometric experience includes her residency at VA Sepulveda Ambulatory There are several differing signs Care Center, Los Angeles, along with and symptoms to distinguish providing medical eye care in both private between the two infections, and a family practice and hospital settings. In good history-taking and physical addition, she's participated in optometric exam should lead you in the right mission trips to El Salvador and Colombia. direction. Ocular pain and redness/swelling of the eyelid are She is a member of the American common features of both entities, Academy of Optometry; the American and therefore offer little help. Optometric Association; and active in Fever, high WBC count, and Optometric Physicians of Washington. conjunctival chemosis are more Dr. Curatola will see patients at our likely in orbital cellulitis, but in Figure 2: Diagram highlighting the location of the orbital septum. Seattle and Renton locations. You can rare cases may be present in reach her at [email protected] (Continued on page 2) (Continued from page 1, Preseptal vs. Orbital Cellulitis) What our patients are preseptal cellulitis. The most important features unique to orbital cellulitis saying… are pain with eye movements, proptosis, double vision, and vision At the end of their treatment, impairment. Examining the pupils is imperative, as a relative afferent we survey patients about their pupillary defect suggests orbital cellulitis and possible impending vision care so we can continue to loss. It is also important to note that sometimes patients report pain with refine our services. We appreciate these recent Signs and symptoms of comments. preseptal and orbital cellulitis Everyone was nice and Clinical feature Preseptal Orbital cellulitis thorough in their explanations cellulitis of procedures to come. I was Eyelid swelling +/- Yes Yes made to feel welcome and erythema relaxed. What I was told is what Eye pain/tenderness May be present Yes; may cause deep happened, and that's always eye pain reassuring. 1/10/2018 Small amount of anxiety Pain with eye No Yes easily allayed by nurse and movements doctor. 1/23/2018 Proptosis No Usually, but may be subtle I was made to feel very comfortable at each stage, pre- op, surgery day and post op. All Diplopia No Usually my questions and concerns were adequately addressed. Vision loss No May be present* The procedures went smoothly and I couldn't be happier with Conjunctival Rarely present May be present the results. 1/25/2018 chemosis Thank you for playing “My Fever May be present Usually present Fight Song” during surgery. Totally uplifting! The whole process for this surgery was High WBC count May be present May be present enjoyable and absolutely amazing!! Fabulous team of *An afferent pupillary defect may signal impending visual loss people. Thank you for restoring great vision to me. 2/16/18 eye movements even when their eye muscles are not inflamed and are You have changed my life. likely just referring to eyelid tenderness. Thank you. 2/16/18 Although the overlap in signs and symptoms can make the task tricky at I felt my experience was great times, it is important to distinguish between preseptal and orbital cellulitis, because of the skill and two conditions with very different clinical implications. professional staff and their commitment to a good outcome for me. 2/27/18 Josh Clermont, OD, joined the NWES team in 2017 and practices at our Seattle clinic, [email protected]. 2 OD Survey Highlights: Your feedback makes us better Thank you to all who completed our recent optometric physician survey. We appreciate your time, comments and suggestions. The information we gather from these surveys shows us where we’ve achieved and where we need to grow. Thank you for working together to help our patients see their best—84% of responding referring providers co-manage their patients with NWES. ODs told us why they refer to NWES: Best Outcomes Reputation of the surgeons Positive patient feedback Relationships built with providing surgeon Location/convenience to the patient ...and what ODs would like us to improve: Consistent/timely communication and documentation by doctors Reduce wait time for scheduling patients We’re planning changes to address these! Practice Update Options for Our Patients: Cornea Cross Linking & Dropless Cataract Surgery Last year, the Food & Drug Administration (FDA) approved corneal cross-linking and some insurance companies are starting to cover the procedure. NWES was one of the first host sites for this research and technology and we’re proud to offer both forms of crosslinking for your keratoconus patients. We offer the FDA approved, epi-off technology, and the option for the epi-on procedure as well. We offer both options to give patients their best possible vision, and accommodate their financial and insurance situations. Our cornea specialist, Audrey Talley Rostov, MD, performs cross-linking at our Seattle location only. To support our cataract patients with limited mobility, dementia or tight budgets, our surgeons adopted dropless cataract surgery as a means of easing the burdens of inserting multiple drops after surgery, and the high costs of these drops, while increasing compliance. Patients with diabetes, glaucoma or known steroid responders are not good candidates for this dropless option. At the end of their cataract surgery, patients receive an injection of compounded medication that reduces swelling and inflammation, while preventing infection. This injection replaces most postoperative drops, though some surgeons may still prescribe a post-op drop separately for a short time. If you’d like to observe dropless cataract surgery or learn more, please contact our Outreach team at 800-826-4631, and ask for Stacy, ext. 3871; or Barbara, ext. 5088. 3 10330 Meridian Ave. N. Suite 370 Seattle, WA 98133 CONTINUING EDUCATION Rostov discusses Femto laser at Hawaiian Eye Conference APRIL 25 | WEDNESDAY Multidisciplinary Medical Cataract and refractive surgeon, Audrey Talley Rostov, MD, spoke on the Symposium on Dermatology advantages of femto laser in complex cataract cases while at the Hawaiian Eye Thomas Freddo, OD, PhD, conference in Maui in January. FAAO; E. James Song, MD, FAAD: Cheryl Gustafson, MD; Dr. Rostov reviewed the benefits that femto laser gives to specific patients with Ingrid Carlson, MD dense cataracts or those with zonular compromise, and the advantages the Lynnwood Convention Center technology provides for surgeons and for patient outcomes. Registration 2:15 p.m. Program 3:00—7:30 p.m. See the video here: http://www.ewreplay.org/content/femtosecond-laser-assisted-cataract-surgery- complex-cases Please visit our Calendar of Events on nweyes.com for more information on CE opportunities. 4 .
Load more

Recommended publications
  • Differentiate Red Eye Disorders
    Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular
    [Show full text]
  • Eyelid and Orbital Infections
    27 Eyelid and Orbital Infections Ayub Hakim Department of Ophthalmology, Western Galilee - Nahariya Medical Center, Nahariya, Israel 1. Introduction The major infections of the ocular adnexal and orbital tissues are preseptal cellulitis and orbital cellulitis. They occur more frequently in children than in adults. In Schramm's series of 303 cases of orbital cellulitis, 68% of the patients were younger than 9 years old and only 17% were older than 15 years old. Orbital cellulitis is less common, but more serious than preseptal. Both conditions happen more commonly in the winter months when the incidence of paranasal sinus infections is increased. There are specific causes for each of these types of cellulitis, and each may be associated with serious complications, including vision loss, intracranial infection and death. Studies of orbital cellulitis and its complication report mortality in 1- 2% and vision loss in 3-11%. In contrast, mortality and vision loss are extremely rare in preseptal cellulitis. 1.1 Definitions Preseptal and orbital cellulites are the most common causes of acute orbital inflammation. Preseptal cellulitis is an infection of the soft tissue of the eyelids and periocular region that is localized anterior to the orbital septum outside the bony orbit. Orbital cellulitis ( 3.5 per 100,00 ) is an infection of the soft tissues of the orbit that is localized posterior to the orbital septum and involves the fat and muscles contained within the bony orbit. Both types are normally distinguished clinically by anatomic location. 1.2 Pathophysiology The soft tissues of the eyelids, adnexa and orbit are sterile. Infection usually originates from adjacent non-sterile sites but may also expand hematogenously from distant infected sites when septicemia occurs.
    [Show full text]
  • Preseptal and Orbital Cellulitis
    Journal of Microbiology and Infectious Diseases / 2014; 4 (3): 123-127 JMID doi: 10.5799/ahinjs.02.2014.03.0154 REVIEW ARTICLE Preseptal and orbital cellulitis Emine Akçay, Gamze Dereli Can, Nurullah Çağıl Yıldırım Beyazıt Univ. Medical Faculty Atatürk Training and Research Hospital Dept. of Ophthalmology, Ankara, Turkey ABSTRACT Preseptal cellulitis (PC) is defined as an inflammation of the eyelid and surrounding skin, whereas orbital cellulitis (OC) is an inflammation of the posterior septum of the eyelid affecting the orbit and its contents. Periorbital tissues may become infected as a result of trauma (including insect bites) or primary bacteremia. Orbital cellulitis generally occurs as a complication of sinusitis. The most commonly isolated organisms are Staphylococcus aureus, Streptococcus pneu- moniae, S. epidermidis, Haempphilus influenzae, Moraxella catarrhalis and S. pyogenes. The method for the diagnosis of OS and PS is computed tomography. Using effective antibiotics is a mainstay for the treatment of PC and OC. There is an agreement that surgical drainage should be performed in cases of complete ophthalmoplegia or significant visual impairment or large abscesses formation. This infections are also at a greater risk of acute visual loss, cavernous sinus thrombosis, meningitis, cerebritis, endo- phthalmitis, and brain abscess in children. Early diagnosis and appropriate treatment are crucial to control the infection. Diagnosis, treatment, management and complications of PC and OC are summarized in this manuscript. J Microbiol Infect Dis 2014; 4(3): 123-127 Key words: infection, cellulitis, orbita, preseptal, diagnosis, treatment Preseptal ve Orbital Sellülit ÖZET Preseptal selülit (PS) göz kapağı ve çevresindeki dokunun iltihabi reaksiyonu iken orbital selülit (OS) orbitayı ve onun içeriğini etkileyen septum arkası dokuların iltihabıdır.
    [Show full text]
  • Orbital Cellulitis Management Guideline – for Adults & Paeds
    ORBITAL CELLULITIS MANAGEMENT GUIDELINE – FOR ADULTS & PAEDS Authors: Stephen Ball, Arthur Okonkwo, Steven Powell, Sean Carrie Orbital cellulitis management guideline – For Adults & Paeds Is it limited to Preseptal Cellulitis? i.e. Eyelid only & eye not involved Oral Co-amoxiclav (clindamycin if penicillin allergic) Consider treating as an outpatient with review in eye casualty in 24-48 hours No Indication for admission – any of: Clinical suspicion of post-septal cellulitis Baseline Investigations Pyrexia FBC, CRP, lactate (& blood culture if Immunocompromised pyrexia) Had 36-48 hours of oral antibiotics Endonasal swab <12 months old unable to assess eye due to swelling Yes Medical management Discharge ADULTS – iv Tazocin (allergy; Iv clindamycin & iv ciprofloxacin) Discharge once swelling PAEDS – iv co-amoxiclav (allergy; iv cefuroxime & has resolved and metronidazole if mild allergy - other allergy discuss with micro) pyrexia settled with IMMUNOCOMPROMISED - discuss all with microbiology/ID oral antibiotics; Consider nasal Otrivine & nasal steroids -co-amoxiclav 4 hourly eye & neuro-observations -clindamycin if Urgent Ophthalmology assessment & daily review penicillin allergic Urgent Otolaryngology assessment & daily review Yes Indication for imaging CNS involvement NO - Discuss Unable to examine eye/open eyelids with Eye signs – any of: proptosis, restriction/pain microbiology/ID on eye movement, chemosis, RAPD, reduced visual acuity/colour vision/visual field, optic nerve swelling No Failure to improve or continued pyrexia after 36-48 hours IV antibiotics Improvement in 36-48 hours Contrast enhanced CT Orbit, Sinuses and Brain Continue medical management, rescan if failure to improve after 36-48 Orbital Collection No Orbital Collection Outpatient Treatment hours Admission Surgical management Medical Management Approach depends on local skill set o Evacuation of orbital pus Imaging o Drainage of paranasal sinus pus Discuss any intracranial complication with both neurosurgery & Microbiology Surgical Management .
    [Show full text]
  • Fulminant Orbital Cellulitis with Compartment Syndrome and Vision Loss Due to Streptococcus Pyogenes: a Case Report
    Indian Journal of Clinical and Experimental Ophthalmology 2020;6(3):467–469 Content available at: https://www.ipinnovative.com/open-access-journals Indian Journal of Clinical and Experimental Ophthalmology Journal homepage: www.ipinnovative.com Case Report Fulminant orbital cellulitis with compartment syndrome and vision loss due to streptococcus pyogenes: A case report Pratima Chavhan1,*, Nirupama Kasturi1, Gayathri Panicker1 1Dept. of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India ARTICLEINFO ABSTRACT Article history: Purpose: To describe an unusual case of fulminant orbital cellulitis with complete vision loss despite timely Received 22-02-2020 medical and surgical management. Accepted 06-04-2020 Observation: Orbital cellulitis is an infective condition of the ocular adnexal structures (fat, periorbita, Available online 30-01-2020 and muscles) behind the orbital septum. A 22-year-old female presented with rapidly progressing orbital cellulitis and was started on empirical intravenous antibiotics. Orbital imaging showing marked proptosis with optic nerve stretching and an extraconal abscess in the medial aspect of left orbit. Emergency lateral Keywords: canthotomy and orbital decompression was done. Streptococcus pyogenes was isolated on culture and Abscess antibiotics changed according to the sensitivity pattern. Lid edema, proptosis, and extraocular movements Compartment syndrome improved but vision deteriorated to absent light perception. Fundus showed disc pallor on follow up.
    [Show full text]
  • Periorbital and Orbital Cellulitis
    JAMA PATIENT PAGE Periorbital and Orbital Cellulitis Periorbital cellulitis is an infection of the eyelid and area around the eye; orbital cellulitis is an infection of the eyeball and tissues around it. Periorbital and orbital cellulitis are infections that most often Periorbital and orbital cellulitis are infections that affect tissues occur in young children. The septum is a membrane that sepa- of the eye in front of and behind the orbital septum. rates the front part of the eye from the back part of the eye. Peri- Periorbital cellulitis affects the skin Orbital cellulitis affects deeper orbital cellulitis is also called preseptal cellulitis because it affects and soft tissue in front of the septum. tissues behind the septum. the structures in front of the septum, such as the eyelid and skin around the eye. Orbital cellulitis involves the eyeball itself, the fat around it, and the nerves that go to the eye. Both of these infec- tions can be caused by bacteria that normally live on the skin or by other bacteria. Symptoms and Causes Orbital septum Orbital septum Periorbital cellulitis often occurs from a scratch or insect bite around Both infections can present with swelling, redness, fever, or pain, but have specific the eye that leads to infection of the skin. Symptoms can include characteristics that can be used to tell them apart along with imaging. swelling, redness, pain, and tenderness to touch occurring around Specific to periorbital cellulitis Specific to orbital cellulitis No pain with movement of eye Pain with movement of eye one eye only. The affected person is able to move the eye in all di- Vision is normal Double vision or blurry vision rections without pain, but there can be difficulty opening the eye- Proptosis (bulging of the eye) lid, often due to swelling.
    [Show full text]
  • Diagnostic Puzzler: Acute Eyelid Edema
    OnlIne ExcLuSive Omar Rayward, MD, Diagnostic puzzler: PhD; Jose Luis Vallejo-Garcia, MD; Paula Moreno-Martin, Acute eyelid edema MD; Sergio Vano-Galvan, MD, PhD Hospital Clinico San Carlos, Madrid, Spain The patient’s eyelid was not inflamed or painful, but it (Dr. Rayward); Humanitas Clinical and Research was swollen enough to impair his vision. What’s your Center, Milan, Italy diagnosis? (Dr. Vallejo-Garcia); Hospital del Henares, Coslada, Madrid (Dr. Moreno-Martin); Hospital Ramón y Cajal, Madrid (Dr. Vano-Galvan) 68-year-old man sought care in our mation (FiGuRE). The patient also had right emergency department for unilateral supraciliary folliculitis that was improving; the [email protected] ptosis following superior and inferior folliculitis had been treated 3 days earlier at a The authors reported no A potential conflict of interest right eyelid edema. The patient said that the primary care facility. relevant to this article. edema had developed 3 days earlier and was We performed a complete ocular exami- getting worse each day; the ptosis was impair- nation, including visual acuity (20/20 in both ing his vision. The patient indicated that the eyes) and found no other significant prob- edema was accompanied by mild burning in lems. Nor did the patient have a fever or any the right periocular region. His medical his- other systemic symptoms. tory included arterial hypertension, which was under control, and bilateral cataract surgery 5 years ago. ● What is Your diAgnosis? On examination, we noted superior and inferior nontender painless eyelid edema on ● HoW Would You Treat This the right eye, with no signs of acute inflam- patienT? FiGuRE Edema of the upper and lower eyelid PHO T o COUR T ES Y OF : o m A r Raywa rd, MD The swelling was not accompanied by inflammation or fever, but it did impair the patient’s vision.
    [Show full text]
  • Orbital Cellulitis
    University of Nebraska Medical Center DigitalCommons@UNMC MD Theses Special Collections 5-1-1933 Orbital cellulitis Warren McClatchey University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Recommended Citation McClatchey, Warren, "Orbital cellulitis" (1933). MD Theses. 277. https://digitalcommons.unmc.edu/mdtheses/277 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected]. ORBITAL CELLULITIS SENIOR Th'"ESIS ORBITAL CELLULI~IS BY Warren McClatchey 1933 I 0R!2.I1:~k-CE~LU~ITIS Introduc·tion The diseas6 known as orbital cell~lltis 1s a purulent inflamation of the cellular tissues of the orbit. The subject is .:)f interest from a diagnostic stand point since it might ue confused with intercranlal condltions. It is also of interest beoause of the relationship it bears to diseases of the nose and acessory sinuses. A good history of the s;J.bject has not yet been written. Anderson Or i tcnet t reported a case to the Ophthalmological Society of the United Kingdom in 1886. (1). The case aad been diagn:)sed as a-horde:)lum. Later thE:Jre occured proJtosis of the rl",ht eye with frontal and orbital pain. The vision was reduced and the reaction to light slug;;:lsh. The temperature 0 was 100 F.
    [Show full text]
  • Periorbital Swelling: the Important Distinction Between Allergy and Infection P W a Goodyear, a L Firth, D R Strachan, M Dudley
    240 Emerg Med J: first published as 10.1136/emj.2002.004721 on 26 February 2004. Downloaded from CASE REPORTS Periorbital swelling: the important distinction between allergy and infection P W A Goodyear, A L Firth, D R Strachan, M Dudley ............................................................................................................................... Emerg Med J 2004;21:240–242. doi: 10.1136/emj.2002.004051 DISCUSSION Orbital cellulitis and abscess formation are rare complica- Orbital cellulitis is an emergency. It is important that it is tions of sinusitis, however acute orbital inflammation is recognised early and managed aggressively. Although the secondary to sinusitis in about 70% of cases. Delay in incidence of orbital cellulitis has remained low with better diagnosis must not occur to avoid serious complications such primary health care and availability of a broad range of as blindness and life threatening intracranial sepsis. A case is antibiotics, it is often a difficult problem to manage and may reported in which despite late referral, emergency surgical cause blindness if left untreated because of optic nerve intervention was sight saving. compression. Both orbital abscess and cavernous venous thrombosis may lead to intracranial spread of infection, such as meningitis or cerebral abscess with high morbidity and possible mortality. 14 year old boy presented to the accident and The serious risk of complications in such cases was made emergency department of a district general hospital clear by Hodges et al1 who studied the outcome in orbital Awith a 24 hour history of a painful swollen left eye, cellulitis in a developing country. They found a high rate of exacerbated by movement. A history of allergy to dog hair complications, 52% blind on admission, with no improve- was noted.
    [Show full text]
  • Isolated Superior Ophthalmic Vein Thrombosis Associated with Orbital Cellulitis: Case Report
    DOI:10.14744/bej.2020.37450 Beyoglu Eye J 2020; 5(2): 142-145 Case Report Isolated Superior Ophthalmic Vein Thrombosis Associated with Orbital Cellulitis: Case Report Zeynep Ozer Ozcan, Alper Mete Department of Ophtalmology, Gaziantep University, Gaziantep, Turkey Abstract Superior ophthalmic vein thrombosis (SOVT) is a rare clinical entity that may be associated with sino-orbital disease. The clinical presentation of SOVT may include signs of venous congestion, such as unilateral ptosis, chemosis, ophthalmoplegia, and eyelid swelling, with or without fundus findings. This case report describes a case of SOVT associated with orbital cellulitis diagnosed with magnetic resonance imaging and treated using anticoagulant therapy, antibiotherapy, and a corti- costeroid. In the presence of orbital cellulitis, clinicians should always keep the possibility of SOVT in mind, as it may result in mortality and visual loss if not diagnosed early and given appropriate treatment without delay. Keywords: Anticoagulant therapy, orbital cellulitis, superior ophthalmic vein thrombosis. Introduction Case Report Superior ophthalmic vein thrombosis (SOVT) is a rare A 52-year-old female patient presented at our clinic with clinical condition that may occur as a result of sino-orbital a history of thyroidectomy related to Graves' disease, dia- disease, trauma, neoplasm, or hypercoagulation (1). The betes, and hypertension. The symptoms were headache; clinical presentation of SOVT may include signs of venous purulent nasal discharge; and pain, swelling, and motility congestion, such as unilateral ptosis, chemosis, ophthalmo- restriction in the right eye that had been ongoing for 1 plegia, and eyelid swelling, with or without fundus findings week. The visual acuity finding was 20/20 in both eyes with (2).
    [Show full text]
  • Answer to Ophthaproblem Continued from Page 55 4. Dacryocystitis
    Ophthaproblem Answer to Ophthaproblem continued from page 55 conducted. It is essential to note any decrease in extra- ocular movement and any signs of proptosis, as these 4. Dacryocystitis are suggestive of orbital cellulitis, a serious ocular com- Dacryocystitis is an inflammation and infection of plication. If discharge is released upon digital palpation the lacrimal sac, usually caused by nasolacrimal duct of the punctum, it should be swabbed and sent for Gram obstruction.1-3 It can be classified as acute, subacute, or stain and blood agar culture (as well as chocolate agar chronic, and can be localized to the sac, extend to the in the pediatric population).1 There is agreement in the pericystitis, or progress further to cause orbital cellu- literature that patients should immediately be started on litis.3 Congenital lacrimal duct obstruction can carry a systemic antibiotics, with further adjustments based on higher chance of secondary infection, leading to dacryo- clinical response and culture or sensitivity results.1,2 The cystocele formation. Most congenital dacryocystoceles severity of the patient’s symptoms, as well as patient will require surgical intervention.4 age, dictates the choice of treatment. In dacryocystitis, patients often present with pain, The following describes the possible therapies for a tearing, redness, and swelling over the lacrimal sac (ie, bacterial or infectious (but currently unidentified) cause the nasal aspect of the lower eyelid) as well as mucoid of dacryocystitis: In an afebrile child with a mild case, 20 or purulent discharge when digital pressure is applied to to 40 mg/kg of oral amoxicillin-clavulanate taken daily the area.1-3 This most commonly occurs in infants and in in 3 divided doses will suffice.
    [Show full text]
  • Concurrent Pseudomonas Periorbital Necrotizing Fasciitis and Endophthalmitis: a Case Report and Literature Review
    pathogens Case Report Concurrent Pseudomonas Periorbital Necrotizing Fasciitis and Endophthalmitis: A Case Report and Literature Review Yu-Kuei Lee 1 and Chun-Chieh Lai 1,2,* 1 Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; [email protected] 2 Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan * Correspondence: [email protected]; Tel.: +886-6-235-3535-5441 Abstract: (1) Background: Necrotizing fasciitis (NF) is an infection involving the superficial fascia and subcutaneous tissue. Endophthalmitis is an infection within the ocular ball. Herein we report a rare case of concurrent periorbital NF and endophthalmitis, caused by Pseudomonas aeruginosa (PA). We also conducted a literature review related to periorbital PA skin and soft-tissue infections. (2) Case presentation: A 62-year-old male had left upper eyelid swelling and redness; orbital cellulitis was diagnosed. During eyelid debridement, NF with the involvement of the upper Müller’s muscle and levator muscle was noted. The infection soon progressed to scleral ulcers and endophthalmitis. The eye developed phthisis bulbi, despite treatment with intravitreal antibiotics. (3) Conclusions: Immunocompromised individuals are more likely than immunocompetent hosts to be infected by PA. Although periorbital NF is uncommon due to the rich blood supply in the area, the possibility of PA infection should be considered in concurrent periorbital soft-tissue infection and endophthalmitis. Citation: Lee, Y.-K.; Lai, C.-C. Keywords: Pseudomonas aeruginosa; necrotizing fasciitis; endophthalmitis Concurrent Pseudomonas Periorbital Necrotizing Fasciitis and Endophthalmitis: A Case Report and Literature Review. Pathogens 2021, 10, 1.
    [Show full text]