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Gibbons AB, Niknahad A, Bacorn C, Halawa O, Li E. Subperiosteal and Orbital Abscesses: A Comparison of Clinical Features, Management, and Outcomes. Ophthalmic Plast Reconstr Surg 2024; 40:161-166. [PMID: 37581883 DOI: 10.1097/iop.0000000000002495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
PURPOSE To compare the clinical features, management, and outcomes between orbital cellulitis patients with subperiosteal abscess (SPA) and those with orbital abscess (OA). METHODS A retrospective study was conducted at a tertiary care center through medical record search to identify patients with orbital cellulitis from January 1, 2000 to December 31, 2022. Charts were screened for those with radiographic evidence of SPA or OA. Demographic data and presenting clinical features were compared between the 2 cohorts. Primary outcomes compared included rates of surgical intervention, reoperation, and readmission; and length of hospital stay and final vision. RESULTS A total of 189 patients, 162 with SPA and 27 with OA, met the criteria. The OA group (mean 46.5 ± 18.6 years) was older than the SPA group (mean 19.1 ± 21.4 years). Comorbid sinusitis was significantly more common in the SPA cohort (95.7% SPA; 70.4% OA; p < 0.001), while OA was more likely to occur with orbital trauma (29.6% vs. 8.0%; p = 0.003), implanted hardware (11.1% vs. 0.6%; p = 0.005), and comorbid diabetes (22.2% vs. 4.3%; p = 0.001). OA patients more often presented with a relative afferent pupillary defect (21.7% vs. 3.9%; p = 0.005), vision worse than 20 of 50 (42.3% vs. 16.2%; p = 0.005), and methicillin-resistant Staphylococcus aureus infection (20.8% vs. 5.8%; p = 0.036). OA was associated with a higher reoperation rate (47.8% vs. 21.3%; p = 0.019), readmission rate (18.5% vs. 5.6%, p = 0.047), and limited extraocular motility at follow-up (4.3% vs. 25%; p = 0.013); while mean length of hospital stay and final visual acuity were similar. CONCLUSION OA may affect an older population with a divergent risk factor profile compared with SPA. OA may cause more severe functional impairment on presentation, warranting more aggressive management to achieve visual outcomes similar to SPA.
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Affiliation(s)
- Alison B Gibbons
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ava Niknahad
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Colin Bacorn
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Omar Halawa
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Emily Li
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
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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] [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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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] [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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Haight S, Adhikari S. Diagnosis of Endophthalmitis and Orbital Abscess by Ultrasound: A Case Report. Clin Pract Cases Emerg Med 2023; 7:262-265. [PMID: 38353198 PMCID: PMC10855287 DOI: 10.5811/cpcem.1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 02/18/2024] Open
Abstract
Introduction The diagnosis of ocular pathology by point-of-care ultrasound (POCUS) has been well established for entities such as retinal detachment, vitreous hemorrhage, posterior vitreous detachment, and lens dislocation.1 However, the use of ultrasound to detect other conditions such as orbital abscess and endophthalmitis in the emergency setting is rarely reported. Case Report We present a case in which POCUS was used to confirm the suspected diagnosis of endophthalmitis and orbital abscess. This case report will review the ultrasonographic findings of orbital abscess and endophthalmitis, as well as briefly discuss the literature for the use of ultrasound for these applications. Conclusion Point-of-care ultrasound can be used to rapidly diagnose infectious pathology of the eye and orbit, which could potentially decrease time to diagnosis and time to consultation of these vision-threatening pathologies.
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Affiliation(s)
- Stephen Haight
- University of California San Francisco, Fresno Medical Education Program, Department of Emergency Medicine, Fresno, California
| | - Srikar Adhikari
- University of Arizona, Department of Emergency Medicine, Tucson, Arizona
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Kulkarni V, Sundaram V, Sameeksha TH. Overwhelming orbital cellulitis in a neonate. BMJ Case Rep 2023; 16:e252390. [PMID: 37491125 PMCID: PMC10373664 DOI: 10.1136/bcr-2022-252390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
This article discusses a rare ophthalmic manifestation of neonatal bacterial infection and its management, including surgical drainage. The case discussed is that of a neonate who presented with rapidly progressing ophthalmic symptoms suggestive of orbital cellulitis. The neonate also had extensive intracranial involvement and had spread to contiguous structures causing a temporal lobe abscess. As there was no local injury, a haematogenous spread was strongly considered. With blood culture and pus culture yielding the growth of Staphylococcus aureus, systemic antibiotics and surgical interventions were required to successfully manage the neonate. Through this case report, we emphasise that orbital infections are grave in neonates and may culminate into devastating intracranial complications; hence, it necessitates appropriate medical and surgical interventions right from hospital admission.
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Affiliation(s)
- Venu Kulkarni
- Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Venkataseshan Sundaram
- Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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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] [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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Ohana-Sarna-Cahan L, Hurvitz N, Gross I, Cohen A, Hashavya S. Factors Associated With Increased Risk of Pediatric Orbital Cellulitis-Who Should Be Scanned? Pediatr Emerg Care 2021; 37:e1473-e1477. [PMID: 32205800 DOI: 10.1097/pec.0000000000002083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evaluation of a child with POC/OC is complicated due difficulties in physical examination and risks of imaging by computed tomography. METHOD Retrospective review of children 0-16 years admitted to the pediatric emergency department for POC/OC from 2009 to 2019. RESULTS Ten years study period, 243 children younger than 16 years presented to the pediatric emergency department with a diagnosis of POC/OC. OC was documented in 51 (20.6%) patients. The mean age was 7.8 years (±4.3 years). Fever (80.4%), upper respiratory tract infection (43%), swelling of both eyelids (96%), proptosis (33.3%), and tenderness on percussion (24.5%) were more common in comparison to POC (P = 0.0001, 0.03, 0.0001, 0.0001, 0.0001 respectively). All children with suspected diagnosis of OC underwent computed tomography scan. POC accounted for 196 patients. Mean age was 4.6 (±4.3) years. Twenty percent of the cases were recorded as local trauma or insect bite in the infected eye.Mean leukocyte count in the OC group had higher mean of 15.2 (109/L) versus 13.4(109/L) (P = 0.05), absolute neutrophil count was significantly higher in the OC 11.3(109/L) versus 7.2(109/L) (P = 0.0001) whereas the lymphocyte count was higher in the POC 4.5(109/L) versus 2.4(109/L) (P = 0.0001), NLR of 0.318 correlates with orbital cellulitis with sensitivity of 75.5% and specificity of 77.4%.Patients with OC had mean C-reactive protein levels of 11.7 (mg/dL) versus 4.9(mg/dL) (P = 0.0001), erythrocyte sedimentation rate was elevated in the OC 53.6 (cm/h) versus 36.4 (cm/h) (P = 0.02).Based on the aforementioned study a risk calculator for OC was formulated with 6 major variables. CONCLUSIONS Differentiation between POC/OC is cardinal. This study highlights the importance of ancillary laboratory tests especially C-reactive protein in the assessment of infections of the eye.
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Affiliation(s)
| | | | - Itai Gross
- Department of Pediatric Emergency Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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8
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Usseglio J, Pagès E, Laloze J, Salle H, Ferri J. A Rare Orbital Subperiosteal Abscess of Dental Origin in a 7-Year-Old Girl. Pediatr Emerg Care 2021; 37:e581-e582. [PMID: 34091573 DOI: 10.1097/pec.0000000000002467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Patel S, Olympia RP. School Nurses on the Front Lines of Healthcare: Getting aHEAD of EmergENT Eye, Ear, Nose, and Throat Infections. NASN Sch Nurse 2021; 37:25-30. [PMID: 34060930 DOI: 10.1177/1942602x211019109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
School nurses may deal with various common infectious eye, ear, nose, and throat-related chief complaints in regular practice. Recognizing the signs and symptoms of severe infection is paramount to preventing life-threatening complications that can have both acute and long-term implications. Distinguishing urgent and emergent eye, ear, nose, and throat conditions to send to the emergency department is integral to reducing the morbidity associated with these conditions. This article discusses three different students presenting with various chief complaints, from the initial assessment by the school nurse to the appropriate disposition and follow-up.
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Affiliation(s)
| | - Robert P Olympia
- Professor, Departments of Emergency Medicine and Pediatrics, Penn State College of Medicine, Attending Pediatric Emergency Medicine physician, Penn State Hershey Medical Center, Hershey, PA
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Abstract
The orbital apex is an undefined but well understood concept of Orbital Surgeons. We sought to determine the surgical apex area specifically where the volume ratio decreases significantly impacting on the optic nerve. A retrospective analysis using PACS program processing, measured the right retrobulbar space volume changes in 100 randomly selected cases without orbital pathology where CT was performed for non-ophthalmic indications. Volume of the retrobulbar space was measured between two recognizable landmarks. The first landmark being the point of exit of the optic nerve from the eye and the second landmark the optic nerve's point of exit from the orbit. The measured length between these two points was divided into five equal segments, V1-V5. The volumes of all 5 segments were compared and the most significant area of volume depletion was established. The mean numeric value of measured orbital volumes was compared. A ratio difference of V1/V2 was less than 2, V2/V3 was 2.32 (± 0.27), V3/4 was 3.24 (± 0.39), and V4/V5 was 5.67 (± 1.66). The most remarkable difference in ratio was between V4 and V5 (mean 5.67 ± 1.66 with p < .0001). The V3 segment (the posterior 3/5 of the retrobulbar space volume) is the location where decrease in orbital volume impacts, and measured ratios are statistically significant. We defined the surgical apex as the posterior 3/5 of the retro-bulbar orbital space. It is consequently the area of higher risk for optic nerve compression. This definition could be routinely utilized by ophthalmologists and neuroradiologists when evaluating masses affecting the orbit.
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Al Akrash LS, Al Semari MA, Al Harithy R. Ocular manifestations of dermatological diseases part I: infectious and inflammatory disorders. Int J Dermatol 2020; 60:5-11. [PMID: 33232519 DOI: 10.1111/ijd.15101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 06/11/2020] [Accepted: 07/13/2020] [Indexed: 12/21/2022]
Abstract
Skin and eyes share a common embryological origin from the embryonic surface ectoderm. Ocular manifestations are one of the most important and common associations of dermatological diseases. Currently, there are few comprehensive reviews of the ocular manifestations of dermatological diseases. We have reviewed more than 40 published articles related to the ocular manifestations of the most important dermatological diseases. The search included Pubmed, Google Scholar, and Cochrane databases from 2014 to 2019. This review was divided into three parts including infections, inflammatory, genetics, connective tissue, autoimmune, neoplasms, and drug-related disorders. We excluded metabolic, endocrine, and nutrition-related dermatological diseases. The relationship of ocular manifestations and dermatological diseases is important to recognize for appropriate management since many dermatological diseases can manifest initially with ocular findings. In this part, we summarized the most common and significant ocular findings in infectious and inflammatory dermatological disorders with appropriate referral recommendations to ophthalmology.
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Affiliation(s)
- Lamia S Al Akrash
- Dermatology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Ruaa Al Harithy
- Dermatology Department, Security Forces Hospital, Riyadh, Saudi Arabia
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12
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Fok JS, Katelaris CH. Angioedema Masqueraders. Clin Exp Allergy 2019; 49:1274-1282. [PMID: 31310036 DOI: 10.1111/cea.13463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/27/2019] [Accepted: 07/05/2019] [Indexed: 12/24/2022]
Abstract
Angioedema is a common reason for referral to immunology and allergy specialists. Not all cases are in fact angioedema. There are many conditions that may mimic its appearance, resulting in misdiagnosis. This may happen when a clinician is unfamiliar with conditions resembling angioedema or when there is a low index of clinical suspicion. In this article, we explore a list of differential diagnoses based on body parts, including the lips, the limbs, periorbital tissues, the face, epiglottis and uvula, as well as the genitalia, that may pose as a masquerader even to an experienced eye.
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Affiliation(s)
- Jie Shen Fok
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Constance H Katelaris
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
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Keorochana N, Vongkulsiri S, Choontanom R. Combined central retinal vein, central retinal artery and cilioretinal artery occlusion with ischemic macular hole secondary to severe orbital cellulitis after black fly bite. Int Med Case Rep J 2019; 12:125-134. [PMID: 31118832 PMCID: PMC6503816 DOI: 10.2147/imcrj.s189082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Orbital cellulitis is an infection of the ocular adnexal and orbital tissues behind the orbital septum. The complications are poor prognosis. This paper is to describe some severe rare complications of orbital cellulitis. Case presentation: A case of 32-year-old female presented with acute severe progressive orbital cellulitis on the right eye after a black fly (Simuliidae spp.) bite. Orbital imaging with computed tomography and magnetic resonance imaging showed eyelid abscess with orbital abscess formation and superior ophthalmic vein thrombosis. She was promptly treated with intravenous vancomycin, piperacillin and had surgical procedures to release orbital pressure including lateral canthotomy, lateral cantholysis, and eyelid with orbital abscess drainage. Pus collection culture was positive for Staphylococcus aureus. Even though she responded well to antibiotics treatment, progression involved severe orbital inflammation with marked increased orbital pressure, and her visual acuity was such that she had no light perception. Combined central retinal vein, central retinal artery and cilioretinal artery occlusion were identified. Fundus examination showed retinal whitening at the posterior pole and a few scattered flame-shaped retinal hemorrhages. The cilioretinal artery presented with perivascular retinal whitening. A fundus fluorescein angiogram revealed cilioretinal and retinal artery filling delay and also delayed arteriovenous transit time. She also developed an ischemic macular hole after a week of treatment. We demonstrate an optical coherence tomography image showing the intact posterior hyaloid membrane that represents no traction on the macula to support the ischemic cause. Conclusion: Multiple retinal vascular occlusion and ischemic macular hole could be an early complication of severe orbital cellulitis from increased orbital pressure; therefore, close monitoring of visual acuity with IOP, and prompt treatment when indicated might reduce the risk of consequent blindness.
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Affiliation(s)
- Narumon Keorochana
- Ocular Inflammatory and Uveitis Division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Sritatath Vongkulsiri
- Retina Division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Raveewan Choontanom
- Oculoplastic and Reconstruction Division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
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