Orbital compression syndrome presenting as orbital cellulitis in a child with sickle cell anemia

Painless recurrent orbital wall infarction secondary to sickle cell disease: A case report

Purpose

Describe the various presentations of the rare entity of orbital wall infarction secondary to sickle cell disease and highlight the importance of magnetic resonance imaging in differentiating the entity from other similar diagnoses.

Observation

A 4-year-old child presented to the hospital with bilateral recurrent painless orbital wall infarction secondary to sickle cell disease. Orbital wall infarctions have been described before in the literature; However, the painless and recurrent nature is intriguing.

Conclusion

Orbital wall infarctions secondary to sickle cell disease represent an unusual presentation of the disease and often pose a diagnostic dilemma. When considering differentiating orbital wall infarctions from other resembling entities, magnetic resonance imaging is considered superior to computed tomography due to its ability to delineate the ischemic changes in the bone marrow, which further aids in the diagnosis. In situations where the orbital wall infarction does not lead to orbital compression syndrome, a conservative approach should suffice.

Orbital bone infarction masquerading as preseptal cellulitis in a child with sickle beta-thalassaemia

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.

Orbital compression syndrome in a Ugandan child with sickle cell disease: A case report

Orbital compression syndrome is a rare acute complication of sickle cell disease that may impair vision. Assessment by a multidisciplinary team incorporates detailed history and physical examination, fundoscopy, and appropriate imaging to exclude infections or neoplasms. Supportive treatment is adequate unless there is evidence of life-threatening space-occupying lesion warranting surgery.

Vaso-occlusive Infarction of the Lateral Orbital Wall With Ipsilateral Temporalis Muscle Ischemia

An 18-month-old boy with sickle cell disease developed progressive left periorbital edema and temporalis fullness. Imaging revealed two inferotemporal subperiosteal fluid collections and adjacent temporalis muscle thickening. After undergoing an anterior orbitotomy with drainage and biopsy, the patient was diagnosed as having a vaso-occlusive sickle cell crisis involving the lateral orbit. [J Pediatr Ophthalmol Strabismus. 2020;57:e78-e81.].

Bilateral Subperiosteal Hematoma and Orbital Compression Syndrome in Sickle Cell Disease

A 14-year-old boy with sickle cell disease presented with preseptal cellulitis findings as proptosis, eyelid edema, and hyperemia. His best corrected visual acuity in the right eye was 20/20 and 16/20 in the left eye. He had limited ductions in vertical and lateral gazes in both eyes. Bilateral venous tortuosity was observed in posterior segment examination. Orbital bone infarction and subperiosteal hematoma were seen in magnetic resonance imaging. He was diagnosed as having orbital compression syndrome secondary to vaso-occlusive crisis of sickle cell disease and was treated with intravenous ampicilin-sulbactam and methylprednisolone.

Sterile subperiosteal fluid collections accompanying orbital wall infarction in sickle-cell disease

Infarction of the orbital wall is an uncommon manifestation of sickle cell disease (SCD) that may mimic an infectious process. We report a patient with two separate orbital infarctions with different presenting symptoms involving different bones. Radiologic-guided sampling of a periosteal fluid collection in the first episode showed likely sterile inflammatory exudates. This case highlights the range of findings in orbital wall infarction in SCD as well as helpful clinical and imaging entities that may differentiate infarction from infection, allowing early diagnosis and appropriate management.

Nontraumatic orbital hemorrhage

Nontraumatic orbital hemorrhage (NTOH) is uncommon. I summarize the published reports of NTOH and offer a classification based on anatomic and etiologic factors. Anatomic patterns of NTOH include diffuse intraorbital hemorrhage, "encysted" hemorrhage (hematic cyst), subperiosteal hemorrhage, hemorrhage in relation to extraocular muscles, and hemorrhage in relation to orbital floor implants. Etiologic factors include vascular malformations and lesions, increased venous pressure, bleeding disorders, infection and inflammation, and neoplastic and nonneoplastic orbital lesions. The majority of NTOH patients can be managed conservatively, but some will have visual compromise and may require operative intervention. Some will suffer permanent visual loss, but a large majority have a good visual outcome.

Bilateral orbital infarction and retinal detachment in a previously undiagnosed sickle cell hemoglobinopathy African child

Bone infarction involving the orbit in sickle cell disease is not common. Bilateral orbital infarction in a previously undiagnosed sickle cell hemoglobinopathy has not been previously reported. In this report, we present a case of an 11-year-old previously undiagnosed sickle cell disease Nigerian girl with severe acute bilateral orbital infarction and retinal detachment to highlight that hemoglobinopathy induced orbital infarction should be considered in African children with acute onset proptosis with or without previous history of sickle cell hemoglobinopathy.

"Sickle Cell Disease in the Emergency Department: Atypical Complications and Management"

Sickle cell disease is the most common inherited blood disorder in the United States. This disorder of hemoglobin structure leads to a chronic hemolytic anemia and complex chronic disease manifested by sudden, severe, and life-threatening complications. These acute complications can occur in any organ system beginning in early childhood and lasting throughout life. The intermittent nature and acuity of these complications lend the emergency department to be an important site of care. The hallmark of sickle cell disease is the vasoocclusive painful event. Other more "typical" complications include fever, acute chest syndrome, priapism, and ischemic stroke. Children with sickle cell disease can also present with other "atypical" complications that can have devastating consequences if they are unrecognized. Detailed discussion of these "atypical" sickle cell disease complications, organized by organ system involved, will be the focus of this article.