Orbital Complications Research Articles

Orbital Complications of Acute Invasive Fungal Rhinosinusitis: A New Challenge in the COVID-19 Convalescent Patients.

Increased incidence of acute invasive fungal rhinosinusitis (AIFR) in the setting of COVID-19 is undeniable. This can be attributed to its effect on innate immunity and extensive use of corticosteroids. The goal of our study was to assess the orbital complications of AIFR and its management in the COVID-19 convalescent patients. Our longitudinal prospective study included 45 patients with orbital complications of AIFR in recently recovered COVID-19 patients. We performed otorhinolaryngological, ophthalmological, and neurological examinations to monitor the manifestations of the disease. Computed tomography and contrast enhanced magnetic resonance imaging were performed to detect the extent of infection. Antifungal medications, surgical intervention, and general condition management were all provided to all the patients. We reported pre-septal cellulitis, orbital cellulitis, and orbital apex syndrome in 18, 13, and 10 patients, respectively. Four patients had cavernous sinus thrombosis. Mucormycosis and Aspergillus species were detected in 80% and 11.11% of our patients, respectively, while the mixed infection was found in 8.88% of our patients. Diabetes mellitus was the most common cause of immunocompromise (95.55% of our patients). Orbital pain and ophthalmoplegia were the most common ocular manifestations, followed by proptosis and relative afferent pupillary defect. All patients underwent surgical intervention, except for one patient who was unfit for surgery. One patient had orbital exenteration. The ophthalmological manifestations were reversible in cases of orbital and pre-septal cellulitis. The overall survival rate was 66.67%. Early diagnosis and treatment of AIFR can decrease the morbidity and mortality rate of affected patients.

A Multi-Institutional Database Review of Orbital Complications and Survival Outcomes in Adult Patients with Invasive or Non-Invasive Fungal Rhinosinusitis.

Invasive fungal rhinosinusitis (IFS) with orbital complications has remained a challenging disease over the past few decades. Only a few studies have been conducted to investigate the factors associated with orbital complications in fungal rhinosinusitis (FRS). We aimed to review the characteristics between IFS and non-invasive fungal rhinosinusitis (NIFS) and determine clinical factors associated with orbital complications and overall survival. A multi-institutional database review study was conducted using the Chang Gung Research Database (CGRD) from January 2001 to January 2019. We identified FRS patients using International Classification of Diseases diagnosis codes and SNOMED CT. We categorized patients into IFS and NIFS groups and analyzed the demographic data, underlying diseases, clinical symptoms, laboratory data, image findings, fungal infection status, and survival outcomes. We included 1624 patients in our study, with 59 IFS patients and 1565 NIFS patients. The history of an organ or hematopoietic cell transplantation had a significant prognostic effect on the survival outcomes, with surgical intervention and high hemoglobin (Hb) and albumin levels recognized as positive predictors. Posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling were risk factors of orbital complications. In NIFS patients, orbital complications were found to be associated with old age, a high WBC count, high blood glucose, and a high CRP level. For the risk factors of orbital complications in IFS patients, posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling were recognized as predictors. Among IFS patients, a history of organ or hematopoietic cell transplantation was a risk factor for poor survival, while, conversely, surgical intervention and high Hb and albumin levels were related to improved survival. As predictors of orbital complications in IFS patients, posterior ethmoid sinus involvement, sphenoid sinus involvement, facial pain, blurred vision, and periorbital swelling upon the first visit should raise attention, with close monitoring.

Does Adenoid Hypertrophy Increase the Risk of Orbital Complication in Children with Acute Sinusitis?

Adenoid hypertrophy (AH) plays a role as a reservoir for bacterial growth and decreases mucociliary clearance which might contribute to the development of an infection. To compare the presence of AH in the pediatric population presenting with orbital complications as a result of ABRS and the control group radiologically. Patients who were diagnosed with OC as a result of ABRS labeled as case group, and the patients who had undergone computed tomography (CT) for indications other than sinonasal diseases were assigned as control group. Both groups were retrospectively reviewed to measure the adenoid, nasopharynx, and adenoid/nasopharynx ratio (ANR) in the axial and mid-sagittal planes. We compared 52 patients from case group to 57 control group. In the CT axial plane, adenoid length was greater in the OC group compared to the control group, with a significant difference (p-value = 0.02) of 14.2 ± 3.5mm compared to 11.2 ± 7mm, respectively. The ANRs were 2.9 in the OC group and 2.8 in the control group, with a p-value of 0.089. In the mid-sagittal plane, only the anteroposterior length was significantly greater in the OC group, with a mean of 19.9 ± 5.3mm compared to 15.2 ± 8.8mm in the control group (p-value = 0.007). The process of inflammation increased the anteroposterior length of the adenoids. However, the ANR was similar between the two groups, indicating that adenoid hypertrophy is not directly related as a risk factor for OC in pediatric patients with ARBS.

Multimodal Imaging in Rhinoorbitocerebral Mucormycosis Associated with Type 2 Diabetes After COVID-19.

This case series analyzed the appropriateness of computed tomography (CT) and magnetic resonance imaging (MRI) for visualization of rhinoorbitocerebral mucormycosis (ROCM) patterns associated with type 2 diabetes (T2D) post-recovery from coronavirus disease 2019 (COVID-19). The study included 24 patients with invasive ROCM after having recovered from COVID-19. All patients underwent CT examinations and microbiological and histological verification; 5 patients underwent MRI. The CT and MRI patterns noted in our patients revealed involvement of skull orbits, paranasal sinuses, large arteries, and optic nerves, with intracranial spread and involvement of the cranial base bones. Using brain scan protocol for CT provided better soft-tissue resolution. We found that extending the MRI protocol by T2-sequence with fat suppression or STIR was better for periantral fat and muscle evaluations. Computed tomography of the paranasal sinuses is the method of choice for suspected fungal infections, particularly mucormycosis. However, MRI is recommended if there is suspicion of orbital, vascular, or intracranial complications, including cavernous sinus extension. The combination of both CT and MRI enables determination of soft tissue invasion and bony destruction, thereby facilitating the choice of an optimal ROCM treatment strategy. Invasive fungal infections are extremely rare in Europe; most of the related data are provided from India and Middle Eastern or African nations. Hence, this study is notable in its use of only diagnosed ROCM cases in Russia.

Revisiting the orbital complications of ARS: What classification has the best clinical applicability?

Revisiting the orbital complications of ARS: What classification has the best clinical applicability?

Unusual complications of acute frontal rhinosinusitis. Two clinical cases

Introduction: Acute frontal rhinosinusitis is defined as an acute infection of the frontal sinus. Spreading of this infection to surrounding structures is uncommon but, when present, carries significant morbidity and mortality. Description: In this case report, we present two unusual cases of frontal rhinosinusitis complications. Firstly, we describe a case of acute rhinosinusitis with orbital complications caused by a frontoethmoidal osteoma. In the second case, the infection extended to the underlying bone and through the skull causing osteomyelitis and focal meningitis complicated with an abscess. After appropriate treatment, both patients were free of infection at follow-up, without complications. Discussion: In the first case we presented, a frontoethmoidal osteoma gave rise to rhinosinusitis with orbital complications. These benign tumors rarely cause symptoms, but when large enough, sinus outflow can be blocked, making the osteoma clinically relevant. Osteomas can induce frontal rhinosinusitis, giving rise, among other conditions, to the development of orbital complications like periorbital cellulitis or the formation of a periorbital abscess. Diagnosis of osteoma is usually straightforward on computed tomography and surgical treatment is only indicated for large tumors, rapid growth, intracranial or orbitary extension. In the second clinical case, the infection extended to the underlying bone and through the skull causing osteomyelitis and focal meningitis with abscess formation. In this patient, a Draf Type IIa procedure was performed for the frontal abscess drainage, followed by proper antibiotic and anti-inflammatory therapy. Conclusions: Complications of frontal rhinosinusitis are uncommon but require immediate attention and aggressive treatment to avoid morbidity and mortality. In these cases, our patients were properly treated with good outcomes, avoiding potentially more dangerous complications.

Orbital apex syndrome secondary to apical periodontitis of a tooth: a case report

BackgroundOrbital apex syndrome (OAS) is a rare disease with a noticeable mortality rate. Although its etiology has been repeatedly assessed, few reports have concentrated on odontogenic infection. We presented a rare case of OAS secondary to apical periodontitis.Case presentationA 61-year-old male was admitted to our hospital for a 3-day history of left orbital and head pain, along with diplopia for 1-day. He also had toothache symptoms before his admission. Due to the atypical early symptoms of orbital apex and cranial nerve injury, no timely and effective diagnosis and treatment were initially provided. However, as the disease progressed and complications occurred, we timely adjusted the diagnosis and successfully controlled the infection. During the one-year follow-up, no recurrence of inflammation was observed; nevertheless, the ptosis and ophthalmoplegia persisted.ConclusionsOAS is a rare, while severe complication of odontogenic infection. This case had various symptoms and nerve injury in the orbital apical area. When disease is atypical in its early stages, treatment is easily overlooked. Early detection and suspicion of orbital apex-related complications should be heightened.

Clinical Markers of Need for Surgery in Orbital Complication of Acute Rhinosinusitis in Children: Overview and Systematic Review.

Background: Although they can occur at all ages, orbital (OC) and periorbital cellulitis (POC) prevail in the pediatric population. Acute rhinosinusitis (ARS) is the most frequent predisposing factor of OC. Recent literature has suggested a medical management approach for OC and POC, with surgery reserved only for more severe cases. However, there is still a lack of consensus on the clinical markers of a need for surgery. The aim of this systematic review was to identify clinical markers of a need for surgery in children with OC. Our systematic review, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) process, yielded 1289 articles finally screened. This resulted in 31 full texts that were included in a qualitative analysis. The results of this review suggest that in children aged over 9 years, large subperiosteal orbital abscesses (SPOAs), impaired vision, ophthalmoplegia, proptosis, elevated C-reactive protein (CRP) and absolute neutrophil counts (ANC), hemodynamic compromise, no clinical improvement after 48/72 h of antibiotic therapy, and a Chandler III score or higher are clinical markers of the need for surgery. However, most of the studies are observational and retrospective, and further studies are needed to identify reliable and repeatable clinical markers of the need for surgery.

Odontogenic Sinusitis is a Common Cause of Operative Extra-Sinus Infectious Complications.

Orbital, intracranial, and osseous extra-sinus complications can arise from bacterial or fungal sinusitis. Odontogenic sinusitis (ODS) can cause extra-sinus complications, but its prevalence remains poorly characterized. To determine the frequency of ODS as a cause of operative extra-sinus infectious complications and describe clinical features of all complicated sinusitis cases. A multi-institutional retrospective review was performed on all operative sinusitis-related extra-sinus complications from 2011 to 2020. ODS was diagnosed by sinus computed tomography (CT) and dental evaluations when available. Demographics, complication types, sinusitis etiologies, and various clinical features were analyzed. Forty-five patients were included (mean age 55.5 years, 56% male). Of the extra-sinus complications, 40% were orbital only, 22% intracranial only, 13% osseous only, and 25% involved combined complications. The 2 most common causes of extra-sinus complications were ODS (40%) and mucopyocele (27%). When invasive fungal etiologies were excluded, and only unilateral maxillary opacification on CT was considered, nearly 60% of extra-sinus complications were due to ODS. Unilateral maxillary sinus opacification on CT was present in 100% of complicated ODS compared to 44% of nonodontogenic cases, and oral anaerobes were only identified in ODS cases. No complicated ODS patients underwent dental interventions during hospitalization. ODS was the most common cause of operative extra-sinus infectious complications. Clinicians should consider ODS high on the differential diagnosis of all patients presenting with complicated sinusitis, especially when sinusitis is unilateral and invasive fungal infection is not suspected.

Diagnosis and treatment of orbital complications of acute sinusitis in 51 children

Objective:To analyze the clinical features, diagnosis and treatment of acute sinusitis related orbital cellulitis in children. Methods:The data of 51 cases with acute sinusitis comorbid with orbital cellulitis in Tianjin Children's Hospital from April 2016 to March 2021 were retrospectively analyzed. According to the extent of infection, the patients were divided into two groups:pre-septal orbital cellulitis（7 cases） and post-septal orbital cellulitis（44 cases）. The general clinical characteristics, clinical manifestations, laboratory examination and treatment were compared between the two groups. Among them, 23 cases（6 in pre-septal orbital cellulitis group and 17 in post-septal orbital cellulitis group） were cured by medicine treatment; 28 cases were cured by surgical treatment after failure of medicine treatment. Results:There was no significant difference in age, gender and medical history between the two groups. Redness, swelling, heat and pain in eyelid was the most common clinical manifestations of orbital cellulitis in children, followed by fever, headache, runny nose, eye fixation, and vision loss. WBC count and neutrophils percentage were significantly higher in post-septal orbital cellulitis group. All children were followed up for 3 months to 3 years， 1 case was lost to follow-up， 50 cases had no recurrence and recovered well. Conclusion:Orbital cellulitis is a common and rapid developing complication of sinusitis in children. Early diagnosis and effective anti-infection treatment are very important for prognosis. Orbital CT plays an important role in the determination and evaluation of this complication. When conservative treatment is ineffective, surgical drainage in time can reduce the occurrence of serious ocular sequelae.

Determinants of treatment outcomes in pediatric patients with acute rhinosinusitis caused orbital complications: observational study

<p><strong>Background:</strong> The aim of the study was to identify predictors of disease severity and describe the characteristics of orbital complications as the direct result of ARS in children.</p><p><strong>Methods:</strong> Through retrospective study, we investigated 78 children with stage I-IV orbital complications between 2005 and 2020 in regional multidisciplinary children's medical center. Samples were obtained for the microbiological analyses. Statistical tests and descriptive statistical methods were used.</p><p><strong>Results:</strong> The research included 78 children who were hospitalized for orbital complications after ARS. There were 44 male patients (56.4%), with a sex ratio of 1.29:1. <em>Staphylococcus aureus</em> was cultured in 31 (34.8%) of patients, followed by <em>Streptococcus pyogenes</em> in 26 (29.2%). We found a significant association between age, severity of complications and treatment outcomes. The age of over seven years was associated with more severe orbital complications (stage II-III) and the need of surgical intervention (p<0.001). Pre-clinical antibiotic administration had no significant influence on illness severity at the time of presentation (p=0.38).</p><p><strong>Conclusions</strong>: In this study, severe orbital complications and the age of over seven years were determinants the antibiotic failure. Clinicians should consider early referral of children older than seven years with orbital complications for better treatment outcomes.</p>

感染性副鼻腔嚢胞による鼻性眼窩内合併症の検討

感染性副鼻腔嚢胞による鼻性眼窩内合併症の検討

Orbital Apex Syndrome and Central Retinal Vein Occlusion after Blow-out Fracture Repair

Purpose: To report a case of orbital apex syndrome and central retinal vein occlusion after blow-out fracture repair.Case summary: A 22-year-old man who underwent emergency re-operation in a department of plastic surgery due to pain, decreased visual acuity, and ophthalmoplegia in all direction after orbital blow-out fracture repair was referred to ophthalmologist on postoperative day 2 and there was no improvement in symptoms. He showed severe complications, including optic neuropathy and ophthalmoplegia in all direction, central retinal vein occlusion, and outer retinal disruption caused by orbital apex hemorrhage. Although we were concerned that it was too late, we started high dose steroid intravenous pulse treatment and the visual acuity, ophthalmoplegia, and retinal findings were improved. However, the optic atrophy and visual field defect did not.Conclusions: After a complicated blow-out fracture repair in other department, if a patient shows severely decreased visual acuity or ocular movement limitation, a thorough and immediate ophthalmologic examination is recommended. During ophthalmologic examination, meticulous examination of the entire eye, including the retina, is required, in addition to general orbital complications. A relatively good prognosis can be expected through accurate cause analysis and appropriate treatment for the confirmed abnormal findings.

Necrotising sinusitis with orbital complication in patient with macrophage activation syndrome (MAS)

Background: Macrophage activation syndrome (MAC) is a potentially fatal clinical-laboratory syndrome of uncontrolled hyperinflammation arising as a result of hereditary or acquired immune-mediated processes of cellular overactivation and nonmalignant proliferation of tissue macrophages/histiocytes, which can cause multiorgan failure. Case report: We present a clinical case of 15-years old child, who was diagnosed with juvenile idiopathic arthritis in 2019. The disease started with macrophage activation syndrome. In the next years the child had multiple hospitalizations in the Pediatrics clinic, but in the course of the disease it developed the picture of severe necrotic pansinuitis with an orbital complication, which required an immediate surgical intervention. Ever since the child had an ongoing necrotizing process in the area of the nasal passages, sinuses, upper jaw and hard palate. Other complications were breakthrough of the hard palate, loss of healthy teeth from the upper dentition and creation of direct communication between the oral cavity and the left maxillary sinus. Conclusions: The diagnosis of MAS is difficult to make, but increased awareness of this disease is an essential for its recognition. The struggle with autoimmune diseases often lasts for years with periods of exacerbation and remission of symptoms. Complications related to them can affect different organs and systems and require interdisciplinary approach.

Computed Tomography Imaging in Orbital Complications of Acute Inflammatory Paranasal Sinuses Diseases

Computed Tomography Imaging in Orbital Complications of Acute Inflammatory Paranasal Sinuses Diseases

Symptomatic enophthalmos due to sphenoid wing dysplasia appearing over 12 years in a patient with neurofibromatosis type 1: a case report and literature review

Sphenoid wing dysplasia (SWD) is a common orbital complication of neurofibromatosis type 1 (NF1). However, enophthalmos associated with SWD is extremely rare, and details of its natural history are unclear. We present the case of a 14-year-old boy with an early childhood diagnosis of NF1 presenting with left blepharophimosis and enophthalmos for several months. Imaging demonstrated enlargement of the left lateral SWD, progression of the posteromedial deviation of the orbital contents, and sphenoid/ethmoid sinus deformation due to left temporal lobe compression over 12 years. Two characteristic changes were revealed on imaging: enlargement of the middle cranial fossa and deformation of the sphenoid/ethmoid sinuses. The orbital contents were compressed by the intracranial pressure of the temporal lobe and were displaced posteromedially into the space created by the deformed sphenoid/ethmoid sinuses. Because orbital symptoms can gradually become apparent over years with the progression of SWD and skeletal growth, long-term follow-up of orbital symptoms is recommended in patients with NF1.

Sino-orbital cutaneous fistula with endoscopy guided technique: A case series.

Introduction and importanceSino-orbital cutaneous fistula (SOCF) directly connects the sinus, orbital space, and outer skin. SOCF has been reported mostly as a complication of orbital exenteration, although it may occur from other infrequent etiologies. The patient can be treated using an endoscopy-guided technique which requires a multidisciplinary approach.Case presentationWe present three cases of SOCF due to less common etiologies (mucocele, chronic inflammation, and malignancy) in young adult patients with a history of orbital and surgical complications. The endoscopy-guided technique benefits from a minimally invasive procedure, having less tissue removal and a faster healing time.Clinical discussionRisk factors of developing SOCF are poor surgical technique, post-operative radiotherapy, concomitant immunocompromised state, diabetes mellitus, hypoproteinemia, or destruction caused by the tumor. The most commonly affected sinus is the frontal (60–89%). Fistula can occur with or without orbital/nasal wall destruction and bony erosion. Before starting the treatment, it is essential to make a precise diagnosis of the etiology and rule out the possibility of recurrence. SOCF can be treated with conservative or invasive management, depending on the severity of the fistula.ConclusionIt is essential to perform a thorough diagnostic examination with radiographic imaging to determine the specific cause before deciding on definitive treatment. By using the endoscopy-guided technique, long-term favorable results can be achieved. Multidisciplinary collaborative teamwork is needed to have a successful result.

Pain management in a child with odontogenic orbital cellulitis and severe complications

Introduction. Orbital cellulitis is a diffuse purulent inflammation of the orbital tissues followed by necrosis. Complications of orbital cellulitis include meningitis or cerebral vascular thrombosis leading to death.Background. We present the case of a 3-year-old child with orbital cellulitis and severe complications treated at the Departmentof Anesthesiology and Intensive Care, CNE “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”.Results. The child presented to the ophthalmology department with complaints of pronounced lid edema and hyperemia, right eye exophthalmos, massive purulent, foul-smelling discharge from the right eye, hyphema of the inner and outer corners of the eye, absent movements of the right eyeball, hyperthermia. Non-contrast computed tomography of the brain revealed osteomyelitis of the right maxilla, cellulitis of the right orbit, right-sided sinusitis, ethmoiditis. Under general anesthesia, there were performed deep orbitotomy, extraction of teeth 54, 55 with the extraction area drainage, puncture of the right maxillary sinus. Multimodal analgesia, detoxification therapy, empiric antimicrobial therapy, immune replacement therapy, protein replacement therapy, and syndromic treatment were chosen. On the 9th day, the child’s condition improved, and he was transferred to the ophthalmology department. On the 27th day of hospital stay, the child was discharged home in a satisfactory condition.Conclusions. The child’s recovery was achieved due to timely hospitalization and surgery, goal-directed antibiotic therapy, application of multimodal anesthesia principles and adequate pain management, immune replacement therapy, usage of non-specific detoxification methods and adequate rehydration therapy.

Management options for orbital complications of acute rhinosinusitis in pediatric patients

ObjectivesAcute bacterial rhinosinusitis (ABRS) is a common pediatric condition. Despite its tendency to heal without complications, orbital complications (OC) are seen in 6% of patients and can cause vision impairment and put life at risk. Current treatment of this complications involves systemic antibiotics with or without surgical drainage, remaining controversial the use of corticosteroids. The aim of this study is to describe our results in the management of this complication both through medical and surgical treatment, with the inclusion of corticosteroids on it. MethodsA retrospective cross-sectional study was conducted in a tertiary hospital over pediatric patients with this complication. Results23 patients were included with a mean age of 7.4 years. Ten of them (43.5%) presented ophthalmoplegia on admission and 2 of those also impaired visual acuity. A computerized tomography was performed in all patients and all of them received intravenous antibiotics and corticosteroids achieving that 60% did not require surgical treatment. The mean length of hospital stay was 6.2 days. ConclusionsThe treatment of OC of ABRS with intravenous antibiotics and corticosteroids is safe, remaining surgical treatment available when necessary. When evolution is favorable, a reduced hospital stay must be sought.

Medical Management as First Line Therapy for Orbital Complications due to acute Rhino sinusitis

Medical Management as First Line Therapy for Orbital Complications due to acute Rhino sinusitis