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Ndiaye-Sow MN, Wade B, Diedhiou F, Gueye NN. [Post-traumatic orbital apex syndrome: Case report]. J Fr Ophtalmol 2024; 47:104087. [PMID: 38378391 DOI: 10.1016/j.jfo.2024.104087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 02/22/2024]
Affiliation(s)
- M N Ndiaye-Sow
- Service d'ophtalmologie de l'hôpital d'instruction des Armées, hôpital principal de Dakar, BP 3006, Dakar, Sénégal.
| | - B Wade
- Service d'ophtalmologie de l'hôpital d'instruction des Armées, hôpital principal de Dakar, BP 3006, Dakar, Sénégal
| | - F Diedhiou
- Service d'ophtalmologie de l'hôpital d'instruction des Armées, hôpital principal de Dakar, BP 3006, Dakar, Sénégal
| | - N N Gueye
- Service d'ophtalmologie de l'hôpital d'instruction des Armées, hôpital principal de Dakar, BP 3006, Dakar, Sénégal
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2
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Lou AY, Wannemuehler TJ, Russell PT, Barahimi B, Sobel RK. Orbital apex syndrome caused by Alternaria species: A novel invasive fungus and new treatment paradigm. Orbit 2019; 39:64-67. [PMID: 30822175 DOI: 10.1080/01676830.2019.1582071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Orbital apex syndrome as a result of invasive fungal sinusitis is a disease entity most commonly found in immunocompromised patients. Infectious invasion affecting the orbital apex can have devastating visual and life-threatening consequences. Mucormycosis and Aspergillus species are the most common causes of such infections. Alternaria fungal sinusitis is a known entity, but its ability to cause an orbital apex syndrome has not yet been reported. Here, we present a case of orbital apex syndrome in an immunocompromised patient with invasive fungal sinusitis caused by Alternaria species. The patient underwent sinus washout and placement of an intraorbital catheter for local instillation of amphotericin B for 10 days, in addition to systemic antifungal treatment, with clinical resolution of infection. The use of an intraorbital catheter for local treatment of fungal infection may offer an exenteration-sparing treatment option in these patients.
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Affiliation(s)
- Alina Y Lou
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul T Russell
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Behin Barahimi
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rachel K Sobel
- Vanderbilt University Medical Center, Nashville, TN, USA
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Hamed-Azzam S, AlHashash I, Briscoe D, Rose GE, Verity DH. Rare Orbital Infections ~ State of the Art ~ Part II. J Ophthalmic Vis Res 2018; 13:183-190. [PMID: 29719648 PMCID: PMC5905313 DOI: 10.4103/jovr.jovr_202_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Infections of the orbit and periorbita are relatively frequent. Identifying unusual organisms is crucial because they can cause severe local and systemic morbidity, despite their rarity. Opportunistic infections of the orbit should be considered mainly in debilitated or immunocompromised patients. The key to successful management includes a high index of suspicion, prompt diagnosis, and addressing the underlying systemic disease. This review summarizes unusual infectious processes of the orbit, including mycobacterial, fungal, and parasitic infections, as well as their pathophysiology, symptoms, signs, and treatment.
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Affiliation(s)
- Shirin Hamed-Azzam
- Orbital Service, Moorfields Eye Hospital, London EC1V 2PD, UK.,St John Ophthalmic Association, London EC1M 6BB, UK
| | | | | | - Geoffrey E Rose
- Orbital Service, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - David H Verity
- Orbital Service, Moorfields Eye Hospital, London EC1V 2PD, UK.,St John Ophthalmic Association, London EC1M 6BB, UK
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A Rare Patient With Orbital Apex Syndrome, Anterior Uveitis, and Necrotizing Scleritis Due to Herpes Zoster Ophthalmicus. J Craniofac Surg 2017; 27:e750-e752. [PMID: 28005810 DOI: 10.1097/scs.0000000000003098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to describe a patient of orbital apex syndrome, anterior uveitis, secondary glaucoma, corneal dellen, and necrotizing scleritis following an attack of herpes zoster ophthalmicus, and the placement of a pericardial patch graft. A 64-year-old male patient with blepharoptosis of his right eye and multiple vesicles on the forehead, nose and cheeks, limitation on all gazes, blepharoptosis, and exophthalmia was eventually diagnosed with ophthalmic zona with orbital apex syndrome. After the treatment with systemic antiviral and steroid, there was complete recovery of the unilateral vesicular eruption, ophthalmoplegia, and ptosis at the third month follow-up. However, anterior uveitis, necrotizing scleritis, secondary glaucoma, and corneal dellen developed during follow-up. At the ninth month, pericardial patch graft (Tutoplast) was placed due to progression of the scleral thinning. Graft vascularization was completed. Careful and long-term follow-up of patients with ophthalmic zona is required for possible ophthalmic complications of varicella zoster virus infections. A pericardial patch graft might be placed due to the development of necrotizing scleritis.
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Abstract
A 68-year-old man presented with periorbital pain with progressive decrease in visual acuity of the right eye. The patient began to experience these symptoms 6 months ago, but they had become significantly worse in the last month. On examination, the patient had ptosis, proptosis, and impaired movement of the right eye. His medical history was notable for peripheral T-cell lymphoma. During chemotherapy, he had developed pulmonary aspergillosis, which resolved with antifungal medication. The magnetic resonance imaging scan, which was taken because of orbital symptoms, was suggestive of optic neuritis. For 6 months, his visual symptoms deteriorated and improved with intermittent steroid treatment. However, the patient began to experience worsening pain and visual disturbance for the month leading up to the referral visit and could not recognize light in the involved eye. A repeat magnetic resonance imaging study revealed a diffuse involvement of right orbital apex. Subsequent to this finding, an endoscopic biopsy was performed. The pathologic examination confirmed the diagnosis of invasive aspergillosis. Orbital pain, ptosis, and limitation of eye movements improved with antifungal medication, and the patient was able to recognize hand movements.
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Abstract
This article reviews four immunocompetent patients who developed a rare fungal infection, mucormycosis, secondary to multiple traumatic injuries sustained during an EF-5 tornado in Joplin, MO. Commonly found in soil and decaying organic matter, mucorales are fungi associated with soft tissue and cutaneous infections. Onset of this fungal infection can occur without clinical signs, presenting several days to several weeks after injury, delaying diagnosis. A multidisciplinary treatment approach including aggressive antifungal therapy and aggressive surgical debridement is critical. This diagnosis should be considered in all patients presenting with injuries sustained from high-velocity embedment of debris such as natural disasters or explosions. We present four cases of mucormycosis, species Apophysomyces trapeziformis. Data reported includes predisposing factors, number of days between injury and diagnosis of mucormycosis, surgical treatment, antifungal therapy, outcomes, and potential risk factors that may have contributed to the development of mucormycosis.
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Kim BM, Kim KH. Successful Treatment of Rhino-Orbital Mucormycosis with Posaconazole after Combination of Surgical Treatment and Amphotericin B. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.6.956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Byung Moon Kim
- Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Keun Hae Kim
- Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea
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Singh H, Kandel R, Nisar S, Das CJ, Dey AB. An unexpected cause of orbital apex syndrome in an immune-competent elderly male. Oxf Med Case Reports 2014; 2014:115-7. [PMID: 25988050 PMCID: PMC4369989 DOI: 10.1093/omcr/omu045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/28/2023] Open
Abstract
Invasive aspergillosis causing orbital apex syndrome (OAS) in an immune-competent individual is a very rare phenomenon, scarcely reported in medical literature. A 68-year-old male presented with progressive loss of vision in the right eye, starting after a cataract surgery. Neurological examination suggested OAS. Imaging was suggestive of mass lesion causing destruction of ethmoid bone. Biopsy of the lesion could not be done initially in view of its proximity to the major neuro-vascular bundle in the orbital apex and cavernous sinus and the major risk involved in the procedure relative to its yield. There was no response to empirical therapy with antibacterials, steroids or Amphotericin-B. Gradually the mass increased in size and was amenable to biopsy. Endoscopy guided biopsy revealed invasive aspergillosis. Switching over to voriconazole lead to successful management. This case highlights the importance of early diagnosis and selection of an appropriate antifungal therapy in the management of invasive aspergillosis.
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Affiliation(s)
- Harjit Singh
- Department of Geriatric Medicine , All India Institute of Medical Sciences , New-Delhi , India
| | - Ramesh Kandel
- Department of Geriatric Medicine , All India Institute of Medical Sciences , New-Delhi , India
| | - Sobia Nisar
- Department of Geriatric Medicine , All India Institute of Medical Sciences , New-Delhi , India
| | - Chandan J Das
- Department of Radiology , All India Institute of Medical Sciences , New-Delhi , India
| | - Aparajit Ballav Dey
- Department of Geriatric Medicine , All India Institute of Medical Sciences , New-Delhi , India
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Baek SU, Lee MJ. A Case of Orbital Apex Syndrome Induced by Penetrating Orbital Injury with Long-Term Results. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.8.1275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Uk Baek
- Department of Ophthalmology, Hallym University College of Medicine, Annyang, Korea
| | - Min Joung Lee
- Department of Ophthalmology, Hallym University College of Medicine, Annyang, Korea
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Ohlstein DH, Hooten C, Perez J, Clark CL, Samy H. Orbital aspergillosis: voriconazole - the new standard treatment? Case Rep Ophthalmol 2012; 3:46-53. [PMID: 22611368 PMCID: PMC3355651 DOI: 10.1159/000336276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background/Aim To describe a case of invasive orbital aspergillosis and evaluate treatments and outcomes. Methods A case report and review of orbital aspergillosis treatment with voriconazole in the English language literature. Conclusion Amphotericin B with debridement is the current standard of care for orbital aspergillosis; however, its prognosis is unfavorable. When compared to amphotericin B, voriconazole demonstrates a survival benefit, has less systemic toxicity, and is better tolerated by patients. While a prospective trial comparing amphotericin B to voriconazole in orbital aspergillosis is not feasible, there is evidence to support the use of voriconazole as primary therapy.
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Affiliation(s)
- Derek H Ohlstein
- Neuro-Ophthalmology Service, Department of Ophthalmology, University of Florida, Gainesville, Fla., USA
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Liu GT, Volpe NJ, Galetta SL. Orbital disease in neuro-ophthalmology. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
A 8-year-old male presented with visual loss, diplopia, ptosis, pain behind the left eye, facial numbness and vomiting of one week duration. The ophthalmological, neurological and radiological examination showed a lesion of the left orbital apex with extension into the cavernous sinus. Examination of the nose and paranasal sinuses did not reveal any abnormality. Transnasal Endoscopic orbital decompression was performed and inflamed granulation tissue found in the orbital apex was removed. Microbiology showed fungal elements which on culture grew Aspergillosis flavus. Antifungal therapy with new generation oral drug (voriconazole) resulted in complete resolution of symptoms. Relevant literature is reviewed and discussed.
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Besada E, Hunter M, Bittner B. An uncommon presentation of orbital apex syndrome. ACTA ACUST UNITED AC 2007; 78:339-43. [PMID: 17601571 DOI: 10.1016/j.optm.2007.04.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 04/09/2007] [Accepted: 04/09/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bilateral total ophthalmoplegia secondary to a malignancy or infection of the cavernous sinus and orbital apex is an unusual presentation. Bilateral ophthalmoplegia as the initial sign of this type of rhinocerebral pathology is also uncommon. CASE REPORT A 34-year old Haitian woman presented with bilateral vision loss, ptosis, total ophthalmoplegia, and ocular pain. A physical and neurologic examination, laboratory analysis, chest x-rays, and neurologic imaging studies were requested. Cranial and facial computed tomography (CT) scans showed swelling of the soft tissues proximal to the sphenoid extending into the dorsal sella and prepontine cistern, obliteration of the nasopharyngeal reflection, opacification of the ethmoid and sphenoid sinus, bony destruction of the mid-skull base, and bilateral lymphadenopathy of the neck. Magnetic resonance imaging (MRI) showed the presence of a soft tissue mass causing destruction of the skull base. Involvement of the clivus, cavernous sinuses, and sella with nasopharynx extension was observed. Hypodense centers within nasopharyngeal tissues suggested the presence of necrosis. Differential diagnosis included nasopaharyngeal carcinoma, lymphoma, or an infectious process. The patient did not consent to a biopsy and refused treatment. CONCLUSION This presentation is a medical emergency. A combination of surgical, medical, or radiological intervention may be required to manage rhino-cerebral diseases responsible for orbital apex syndrome. Despite advances in neurologic imaging, histologic examination of tissue obtained from a biopsy may ultimately be necessary to obtain a precise diagnosis.
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Affiliation(s)
- Eulogio Besada
- Nova Southeastern University College of Optometry, Ft. Lauderdale, Florida 33162, USA.
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O'Neill BM, Alessi AS, George EB, Piro J. Disseminated rhinocerebral mucormycosis: a case report and review of the literature. J Oral Maxillofac Surg 2006; 64:326-33. [PMID: 16413907 DOI: 10.1016/j.joms.2005.10.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2004] [Indexed: 10/25/2022]
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15
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Abstract
Painful ophthalmoplegias have numerous etiologies and are often the presenting sign of a severe disease. Anatomic localization of the lesion is essential in interpreting neuroimaging.
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Affiliation(s)
- V Biousse
- Neuro-Ophthalmology Unit, Emory Eye Center, Atlanta, GA 30322, USA.
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16
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Milbrandt K, Classen D. An 89-year-old woman with cranial nerve dysfunction: diagnosis by observation. CMAJ 2005; 172:632. [PMID: 15738486 PMCID: PMC550631 DOI: 10.1503/cmaj.1041089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kris Milbrandt
- Division of Plastic Surgery, Department of Surgery, University of Saskatchewan, Saskatoon, Sask
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Machleder DJ, Banik R, Rosenberg RB, Parikh SR. An unusual case of rhabdomyosarcoma presenting as orbital apex syndrome. Int J Pediatr Otorhinolaryngol 2005; 69:249-54. [PMID: 15656960 DOI: 10.1016/j.ijporl.2004.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 07/16/2004] [Accepted: 07/17/2004] [Indexed: 11/22/2022]
Abstract
PRECIS A 12-year-old female presented with symptoms and signs of orbital apex syndrome (OAS), secondary to stage IV alveolar rhabdomyosarcoma (RMS) originating in the sphenoid and ethmoid sinuses. OBJECTIVE To present a case of alveolar rhabdomyosarcoma, unusual in its presentation as orbital apex syndrome and also its origin from the sphenoid and ethmoid sinuses. DESIGN : Observational case report. METHODS Ophthalmologic findings, neuroimaging, medical and surgical intervention, histopathologic analysis, and clinical course are described. RESULTS A 12-year-old female presented with progressive visual loss in her left eye, difficulty with eye movements, and mild headache. Her examination was consistent with orbital apex syndrome. Imaging with contrast revealed a mass originating in the left sphenoid and ethmoid sinuses invading the left optic canal. Emergent biopsy was interpreted as alveolar rhabdomyosarcoma; subsequent metastatic work-up revealed bone marrow metastases. The patient was diagnosed with stage IV alveolar rhabdomyosarcoma and immediately started on combination orbital radiation therapy (RT) and systemic chemotherapy. She experienced gradual improvement of ocular motility, though her optic neuropathy persisted. CONCLUSION Alveolar rhabdomyosarcoma of paranasal origin, specifically from the sphenoid and ethmoid sinuses, should be included in the differential diagnosis for orbital apex syndrome in children.
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Affiliation(s)
- Daniel J Machleder
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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18
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Abstract
PURPOSE OF REVIEW Visual loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves are the hallmarks of an orbital apex syndrome. Historically, the terms superior orbital fissure, orbital apex, and cavernous sinus have been used to define the anatomic locations of a disease process. However, the diagnostic evaluation and management is similar for each of these entities. The authors reviewed the literature on the diagnosis and evaluation of disorders involving the orbital apex. RECENT FINDINGS High-resolution MRI is the preferred modality for evaluating most lesions involving the orbital apex. CT is a useful tool in the setting of trauma, to evaluate bone involvement, or when MRI is contraindicated. Although laboratory studies may be useful adjuncts in the diagnostic evaluation of lesions involving the orbital apex, surgical biopsy is often required for definitive diagnosis. SUMMARY Orbital apex syndromes may result from a variety of inflammatory, infectious, neoplastic, iatrogenic/traumatic, and vascular conditions. A detailed history with review of systems is important in narrowing the differential diagnosis. Management is directed at the underlying cause and may be guided by surgical biopsy. Corticosteroids may be useful if an inflammatory etiology is suspected, but should be used with caution.
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Affiliation(s)
- Steven Yeh
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas 77030, USA
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Fernandes YB, Ramina R, Borges G, Queiroz LS, Maldaun MV, Maciel JA. Orbital apex syndrome due to aspergillosis: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2001; 59:806-8. [PMID: 11593288 DOI: 10.1590/s0004-282x2001000500029] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report the case of a 73-year-old female who presented facial numbness and pain in the first division of the trigeminal nerve, ptosis, diplopia and visual loss on the right side for the previous four months. The neurological, radiological and histological examination demonstrated a rare case of invasive fungal aspergillosis of the central nervous system, causing orbital apex syndrome, later transformed in temporal brain abscess. She died ten months later due to respiratory and renal failure in spite of specific antimycotic therapy.
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Affiliation(s)
- Y B Fernandes
- Disciplina de Neurocirurgia, Departamento Neurologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, SP, Brasil.
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Srinivasan S, Fern AI, Wilson K. Orbital apex syndrome as a presenting sign of maxillary sinus carcinoma. Eye (Lond) 2001; 15:343-5. [PMID: 11450740 DOI: 10.1038/eye.2001.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Fairley C, Sullivan TJ, Bartley P, Allworth T, Lewandowski R. Survival after rhino-orbital-cerebral mucormycosis in an immunocompetent patient. Ophthalmology 2000; 107:555-8. [PMID: 10711895 DOI: 10.1016/s0161-6420(99)00142-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Rhino-orbital-cerebral mucormycosis is usually associated with a poor prognosis and is almost exclusively seen in immunocompromised patients. We report the third documented case of rhino-orbital-cerebral mucormycosis caused by Apophysomyces elegans (a new genus of the family Mucoraceae first isolated in 1979) in an immunocompetent individual. Orbital exenteration and radical debridement of involved adjacent structures combined with intravenous liposomal amphotericin resulted in patient survival. DESIGN Interventional case report. METHOD A 59-year-old immunocompetent white man sustained a high-pressure water jet injury to the right inner canthus while cleaning an air conditioner filter. He later had "orbital cellulitis" develop that did not respond to antibiotics and progressed to orbital infarction. Imaging studies and biopsy results led to a diagnosis of mucormycosis. Tissue culture grew Apophysomyces elegans, a new genus of the family Mucoraceae first isolated in 1979. Orbital exenteration and radical debridement of involved adjacent structures, combined with intravenous liposomal amphotericin, resulted in patient survival. RESULTS After orbital exenteration and debridement of involved adjacent structures along with intravenous liposomal amphotericin, our patient has remained free from relapse with long-term follow-up. CONCLUSIONS The agent causing this case of rhino-orbital-cerebral mucormycosis (Apophysomyces elegans) contrasts with the three genera most commonly responsible for mucormycosis (Rhizopus, Mucor, and Absidia) in that infections with this agent tend to occur in warm climates, by means of traumatic inoculation, and in immunocompetent patients. Rhino-orbital-cerebral mucormycosis should be considered in all patients with orbital inflammation associated with multiple cranial nerve palsies and retinal or orbital infarction, regardless of their immunologic status. A team approach to management is recommended for early, appropriate surgery and systemic antifungal agents.
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Affiliation(s)
- C Fairley
- Eyelid, Lacrimal and Orbital Clinic, Division of Ophthalmology, Royal Brisbane Hospital, Australia
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22
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Eustis HS, Mafee MF, Walton C, Mondonca J. MR imaging and CT of orbital infections and complications in acute rhinosinusitis. Radiol Clin North Am 1998; 36:1165-83, xi. [PMID: 9884695 DOI: 10.1016/s0033-8389(05)70238-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The acute onset of orbital and periorbital inflammation presents the clinician with a diagnostic and therapeutic dilemma, the consequence of which may be very serious. The progression from the initial stage of cellulitis to orbital abscess, cavernous sinus thrombosis, brain abscess, meningitis, or visual loss may be quite rapid at times. CT, ultrasonography, and MR imaging play an important role in clinical management of these patients. Indeed, it is the information obtained through orbital imaging that directs the clinician to use the correct therapeutic modality.
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Affiliation(s)
- H S Eustis
- Department of Ophthalmology, Ochsner Clinic, New Orleans, Louisiana, USA
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Lee PS, Mak W, Ip P, Collins RJ. Case report: 'Orbital pseudo-pseudotumour'--a fatal case of steroid-responsive painful ophthalmoplegia. Clin Radiol 1998; 53:774-7. [PMID: 9817099 DOI: 10.1016/s0009-9260(98)80324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- P S Lee
- Department of Diagnostic Radiology, Queen Mary Hospital, Hong Kong
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Luna JD, Ponssa XS, Rodríguez SD, Luna NC, Juárez CIP. Intraconal Amphotericin B for the Treatment of Rhino-Orbital Mucormycosis. Ophthalmic Surg Lasers Imaging Retina 1996. [DOI: 10.3928/1542-8877-19960801-10] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Abstract
Mucormycosis is a highly aggressive fungal infection affecting diabetic, immunocompromised, and, occasionally, healthy patients. This infection is associated with significant mortality. We have reviewed 208 cases in the literature since 1970, 139 of which were presented in sufficient detail to assess prognostic factors, and added data from six of our patients. The histories of these 145 patients were analyzed for the following variables: 1) underlying conditions associated with mucormycotic infections; 2) incidence of ocular and orbital signs and symptoms; 3) incidence of nonocular signs and symptoms; 4) interval from symptom onset to treatment; and 5) the pattern of sinus involvement seen on imaging studies and noted at the time of surgery. Factors related to a lower survival rate include: 1) delayed diagnosis and treatment; 2) hemiparesis or hemiplegia; 3) bilateral sinus involvement; 4) leukemia; 5) renal disease; and 6) treatment with deferoxamine. The association of facial necrosis with a poor prognosis fell just short of statistical significance, but appears clinically important. This is the first review that documents the heretofore intuitive claim that early diagnosis is necessary to cure this disease. Standard treatment with amphotericin B and aggressive surgery are reviewed and adjunctive therapeutic modalities are discussed, including local amphotericin B irrigation, hyperbaric oxygen, and optimizing the immunosuppressive regimen in transplant patients. Hyperbaric oxygen was found to have a favorable effect on prognosis. In addition, possible treatment options for patients with declining renal function are reviewed.
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Affiliation(s)
- R A Yohai
- Wright State University School of Medicine, Dayton, Ohio
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26
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Abstract
BACKGROUND The authors define orbital infarction as ischemia of all intraorbital and intraocular structures. It is a rare disorder due to the rich anastomotic vascularization of the orbit. PATIENTS The authors report three patients with orbital infarction with similar clinical presentations: acute blindness, orbital pain, total ophthalmoplegia, and anterior and posterior segment ischemia. RESULTS Etiologies of orbital infraction syndrome include occlusion of the common carotid artery (case 1), giant-cell arteritis (case 2), and mucormycosis (case 3). CONCLUSION Three cases discussed in this article illustrate that orbital infarction is a disorder that can occur secondary to different mechanisms such as (1) acute perfusion failure (e.g., common carotid artery occlusion [possibly combined with anomalous orbital anastomotic channels]), 2) systemic vasculitis (e.g., giant-cell arteritis), and (3) orbital cellulitis with vasculitis (mucormycosis). The blindness and retinal and optic nerve damage were permanent, whereas the other signs of orbital ischemia (ophthalmoplegia and anterior segment ischemia) resolved. Therefore, diagnosis of orbital infarction can best be made during the acute phase.
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Affiliation(s)
- F X Borruat
- Hôpital Ophtalmique Jules Gonin, University Eye Clinic, Lausanne, Switzerland
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Abstract
The histopathologic findings in a case of ocular invasion in rhinocerebral mucormycosis are described. The findings of hyphae in the inner sclera and marked involvement of the posterior ciliary arteries suggested an arterial route of ocular invasion by fungus. Only five other cases of rhinocerebral mucormycosis with ocular fungal invasion have been reported to our knowledge. All six patients died from the infection. As a group, these cases suggest that the presence of ocular infiltration by fungus may indicate poor prognosis in rhinocerebral mucormycosis.
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Affiliation(s)
- T A Sponsler
- Department of Ophthalmology, Milton S. Hershey Medical Center, Penn State University, Hershey
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28
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Luo QL, Orcutt JC, Seifter LS. Orbital mucormycosis with retinal and ciliary artery occlusions. Br J Ophthalmol 1989; 73:680-3. [PMID: 2765451 PMCID: PMC1041846 DOI: 10.1136/bjo.73.8.680] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 61-year-old man presented with acute, painful loss of vision in the left eye due to a central retinal artery occlusion. Fluorescein angiography confirmed the central retinal artery occlusion and also identified a nasal posterior ciliary artery occlusion. CT scanning revealed a left medial orbital mass with adjacent ethmoid sinusitis. Transnasal ethmoid biopsy disclosed mucormycosis. A left external ethmoidectomy, maxillectomy, and orbital exploration were performed, after which the patient was treated with daily intravenous amphotericin B for six weeks. Coexistence of retinal and nasal posterior ciliary artery occlusion due to mucormycosis may relate to their common origin from the ophthalmic artery. Treatment without exenteration was successful.
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Affiliation(s)
- Q L Luo
- Department of Ophthalmology, University of Washington School of Medicine, Seattle 98195
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29
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The Immunocompromised Host. Dermatol Clin 1989. [DOI: 10.1016/s0733-8635(18)30605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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