Preseptal Cellulitis Research Articles

Case Report of Benign Diffuse Anterior Scleritis Associated with SARS-CoV-2

COVID-19 is an emerging infectious disease classified as a zoonotic illness caused by the SARS-CoV-2 strain of coronavirus. This enveloped, positive-sense, non-segmented RNA virus belongs to the order Nidovirales and the family Coronaviridae. Its primary mode of transmission is human-to-human through respiratory droplets. Ophthalmologists worldwide have reported various ocular manifestations associated with the infection. Recent studies have shown that SARS-CoV-2 binds to the cellular receptor for angiotensin-converting enzyme 2 (ACE2) and interacts with the transmembrane serine protease 2 (TMPRSS2), both of which are known to be expressed in the human cornea, retina, and conjunctival epithelium [1, 2]. The aim of this work is to present a case of a patient who developed diffuse viral scleritis related to COVID-19, detailing the diagnostic and therapeutic approaches as well as the patient's progression. We report the case of a 63-year-old man with a history of high triglycerides who developed flu-like symptoms and severe tiredness for over a week. A COVID-19 test came back positive. Ten days later, he had a painful, red right eye but no change in vision. An eye exam showed some redness in the conjunctiva, a clear cornea, and normal pressure in the eye. The fellow eye looked normal as well. He was treated with topical steroids and artificial tears, which helped initially. However, after finishing treatment, his symptoms worsened with more redness and pain, and now both eyes were affected. Further examination of the right eye showed swelling of the eyelid (preseptal cellulitis) and widespread redness in the conjunctiva. The Neosynephrine test was negative, and there was pain when moving the eye. The cornea was clear but had some superficial punctate keratitis, and the anterior chamber looked normal. The left eye also showed redness but was otherwise normal. A full lab workup (including blood tests and serologies for HSV1-2) came back normal. Considering his previous C

Evaluation of moderate periorbital cellulitis and home-based therapy in children (EPOCH study, Part 2): A prospective single centre cohort study.

Paediatric periorbital cellulitis, a common eye condition, typically requires inpatient admission for intravenous antibiotics due to concerns about orbital spread. This study aimed to assess the safety and effectiveness of ambulatory management for children with moderate periorbital cellulitis. Over a 24-month period, we prospectively enrolled 84 children aged 1 to 16 years who presented with moderate periorbital cellulitis to the emergency department. Demographic and clinical data were collected. Following a guideline-based decision tree, eligible children received intravenous antibiotics and were discharged with a peripheral cannula for follow-up in ambulatory care and ophthalmology clinics. Descriptive statistics were used for data presentation. Among the 84 children, 62 (73.8%) were managed through the ambulatory care model. Within the category of moderate POC, those who were admitted to the hospital did not have higher CRP or White Cell counts and received IV antibiotics for the same length of time. The ambulatory care clinic provided a total of 132 daily doses of intravenous antibiotics. Two children treated on this pathway required inpatient admission due to clinical deterioration, one of whom required ophthalmic surgical intervention. There was no mortality or sight-threatening complications in this study. Implementing a directed ambulatory care pathway for children with moderate periorbital cellulitis proved to be an effective and safe management strategy. This approach reduces the strain on hospital bed occupancy while promoting community-based patient care.

A NOVEL TREATMENT FOR PTOSIS COMPLICATION AFTER PRESEPTAL CELLULITIS IN DIABETIC PATIENT (CASE REPORT

Background: Preseptal cellulitis (PC) is an inflammation of the eyelid and surrounding soft tissues covering the anterior portion of the orbital septum (palpebral fascia) characterized by eyelids unilateral swelling, can develop to orbital cellulitis and be fatal for diabetics after complication. Two main mechanisms of the PC development are distinguished. One of them is based on a spread of local infection on the eyelid. The second group of PC causes include eye surgery, trauma or insect bites. In most cases, serious complications are rare, but sometimes sight-threatening infections behind the orbital septum may develop. It is important to be able to distinguish periorbital cellulitis from orbital cellulitis, and treat according to the diagnosis. In this paper, we discuss a case of PC and successful recovery after medical intervention even though due to late presentation to the Clinic, patient developed ptosis. A clinical case of PC developed to complete ptosis, treatment and successful elimination of all residual symptoms in diabetic patient with is described. We used a novel approach to PC treatment and ptosis after PC. Results: We achieved complete recovery from ptosis after PS in a diabetic patient thanks to novel approach to treatment Findings: 1. The use of nepafenac instead of diclofenac helps to enhance the effectiveness of treatment and prevent the spread of infection to nearby tissues during PС. 2. For the treatment PC complication, ptosis, we suggest the simultaneous, not separated in time use of proserin in combination with glycine.

A Case of Orbital Abscess Caused by Prevotella baroniae Infection

Purpose: We report a case in which <i>Prevotella baroniae</i>, an oral pathogen, was transmitted to the orbit, leading to the development of orbital abscess.Case summary: A 56-year-old female presented with persistent ocular pain, eye movement limitation, periorbital swelling and erythema on the left eyelid. The patient had a history of aplastic anemia and had undergone sequestrectomy surgery for maxillary osteomyelitis and exposed sinus bone on the left side of the face in the past. Orbit magnetic resonance imaging revealed irregular enhancement and disruption of the left orbital floor, indicative of cellulitis. The patient was thus diagnosed with periorbital cellulitis and orbital abscess. Debridement was performed, and purulent discharge was observed and a culture was performed. The culture identified <i>P. baroniae</i>, suggesting a spread of infection from oral, dontogenic infection to the orbit. The patient showed improvement after intensive antibiotic treatment.Conclusions: Orbital abscesses should be treated with appropriate necrotic tissue debridement, drainage, and intensive and effective antibiotics. This is the first report of an orbital abscess caused by orbital transmission of <i>P. baronii</i>, an oral infection, in Korea.

Improving Antibiotic Use in Pediatric Preseptal Cellulitis Using a Clinical Practice Guideline.

The purpose of this study was to evaluate the impact of a clinical practice guideline (CPG) on antibiotic use and resource utilization for pediatric preseptal cellulitis. This retrospective quasiexperimental study included patients between the age of 2 months and 17 years admitted for preseptal cellulitis between January 2013 and December 2023. The preseptal cellulitis CPG was implemented in December 2020 using a multifaceted strategy that included buy-in from key stakeholders, education of frontline providers, the official CPG launch, and stakeholder check-ins. The primary outcome was the use of broad-spectrum antibiotics, including dual/triple therapy and methicillin-resistant Staphylococcus aureus (MRSA) active antibiotics. The secondary outcome was resource utilization including blood testing and imaging. Outcomes were compared pre- and post-CPG implementation using the Fisher exact test and logistic regressions. Of 236 patients meeting inclusion criteria, 175 and 61 patients composed the pre- and post-CPG cohorts, respectively. Median age (interquartile range) was 4.0 (1.8-8.3) years and 46% of the population were female. Post-CPG implementation changes in empirical antibiotic use included decreases in broad-spectrum use from 100% to 66% (P < .001), dual/triple therapy from 47% to 16% (P < .001), and MRSA active agents from 86% to 26% (P < .001). There was a decrease in complete blood count and blood culture orders from 75% to 57% (P = .014) and 32% to 18% (P = .047), respectively. Use of broad-spectrum antibiotics, including dual/triple therapy and MRSA active antibiotics for the treatment of pediatric preseptal cellulitis, decreased after CPG implementation.

Differentiation of bacterial orbital cellulitis and diffuse non-specific orbital inflammation on magnetic resonance imaging.

To examine the radiological differences between bacterial orbital cellulitis (OC) and diffuse non-specific orbital inflammation (DNSOI) on magnetic resonance imaging (MRI). Retrospective study of patients with OC and DNSOI with an MRI orbital scan. Localised orbital inflammation (e.g., idiopathic dacryoadenitis and myositis), quiescent orbital inflammation and pre-septal cellulitis were excluded. Thirty-two patients presenting between 2008 and 2023, including twenty-one OC patients (mean age: 42.5 ± 24.9 years old, male: 6), and eleven DNSOI patients (mean age: 52.3 ± 17.8 years old, male: 16). Both OC and DNSOI demonstrate orbital fat contrast-enhancement. However, whilst OC demonstrated a hyperintense T2 signal (P < 0.001), variable signal was observed in DNSOI, with a hypointense T2 signal more suggestive of DNSOI (P = 0.012). When the lacrimal glands were involved, indistinct margins were more likely in OC (P < 0.001), whilst gross enlargement and contrast-enhancement was observed in DNSOI (P = 0.032 and 0.017, respectively). Peripheral contrast-enhancement of the extraocular muscle (EOM) (P = 0.002) was more common in OC, whilst DNSOI demonstrated variable contrast-enhancement throughout the affected EOM (P < 0.001). The presence of contralateral abnormalities, such as lacrimal gland enlargement and EOM involvement, are more suggestive of DNSOI. Several MRI features, beyond overt sinogenic disease, may help to differentiate OC from DNSOI, including the orbital fat signal intensity, EOM and/or lacrimal gland involvement, and contralateral orbital abnormalities. However, these features may not be specific, and thus highlights the ongoing radiological dilemma clinicians are faced when tasked with differentiating between infectious and non-infectious orbital inflammatory disease.

Pre-septal and Orbital Cellulitis: A Retrospective Analysis of Manifestations and Outcomes of a Tertiary Center in Kuwait.

Introduction Orbital cellulitis is an infectious condition that presents a gap in the literature in regard to its manifestations in the Middle East. A retrospective investigation was undertaken at one tertiary care facility in Kuwait, aiming to augment regional insights into the etiological factors and subsequent outcomes associated with this condition. Methods A retrospective review collected data from 92 patients in a tertiary care center in Kuwait for patients admitted with pre-septal and orbital cellulitis between January 2013 and June 2023. Primary outcomes assessed the resolution of symptoms, categorized as "completely resolved" and "resolved with complications". Secondary outcome measures included patients' ages, microbiology, laboratory, and radiological findings. Gender, predisposing conditions, surgical status, and orbital involvement were additionally extracted and analyzed descriptively. Results Data of n=92 (56 males and 36 females) were extracted. Ages ranged from 20 days to 18 years, the mean being seven years. Additionally, 52.2% (n=48) were diagnosed with orbital cellulitis, and 42.4% (n=39) were diagnosed with pre-septal cellulitis on admission. Cultures were available for n=60. Specifically, 52.1% (n=48) received CT scans; 6.5% (n=6) MRI scans; and 98.9% (n=91) received antibiotics (microbiology investigated: n=83). Ceftriaxone was used in 82.6% (n=76); 20.6% (n=19) received surgical interventions, and incision and drainage (I&D) were done on 15.2% (n=14). Visual acuity was assessed in 59.7% (n=55) patients. Five (5.43%) reported visual deterioration, and 87 (94.6%) of the outcomes were classified as "completely resolved". Conclusion Upper respiratory tract infections were the most common documented predisposing risk factor in the development of pre-septal and orbital cellulitis. Adverse outcomes in vision were documented in 5.43% of patients. A paucity of regional data highlights the importance of conducting further studies locally.

A rare case of trigeminal trophic syndrome with periorbital cellulitis and full-thickness upper eyelid defect in an undiagnosed patient with human immunodeficiency virus: a case report

BackgroundTrigeminal trophic syndrome is a rare cranial and facial condition caused by damage to the central or peripheral branches of the trigeminal nerve. This syndrome consists of a triad of anesthesia, paresthesia, and crescent-shaped facial ulcer involving the ala nasi and sometimes extending to the upper lip. Although previous screening for human immunodeficiency virus in some patients with trigeminal trophic syndrome was negative, we present a unique case of trigeminal trophic syndrome who tested positive for human immunodeficiency virus with eye complications.Case presentationWe present a rare case of trigeminal trophic syndrome in a 44-year-old Black African woman who tested positive for human immunodeficiency virus. She presented with a 6-week history of progressive, persistent, and painless left sided facial and scalp ulcerations that started as small skin erosion. Diagnosis of trigeminal trophic syndrome was made on clinical grounds based on the triad of anesthesia, paresthesia, and unilateral crescent-shaped ulcer in the trigeminal dermatome and her past medical history. The ulcer healed completely after counseling and pharmacological therapy, but she later developed left periorbital cellulitis and left upper eyelid full-thickness defect.ConclusionThis is by far the first documented case of trigeminal trophic syndrome with a positive human immunodeficiency virus test. Testing for human immunodeficiency virus in patients with trigeminal trophic syndrome is necessary as this can help improve clinical management and treatment outcomes. Seeking the services of specialists remotely in resource constraint settings is beneficial for managing complications associated with trigeminal trophic syndrome.

A REPERTOIRE OF ACUTE DACRYOCYSTITIS

Background: Clinical features of acute dacryocystitis comprise of three stages- stage of cellulitis, lacrimal abscess and fistula formation. Infective odontogenic focus is one of the known etiologies for acute dacryocystitis. Pre-septal cellulitis is the most common presentation associated with epiphora. Tenacious inflammation of sac or distal nasolacrimal duct obstruction can result in a lacrimal abscess. Unattended abscess may consequently form a fistula. Acute dacryocystitis rarely can get complicated to cause orbital cellulitis overstriding the anatomic barriers. Case Presentation: Case1: A 72/F complained of toothache since a week, followed by diffuse swelling below lower eyelid, pain and discharge near medial canthus. The case was diagnosed as acute dacryocystitis with pre-septal cellulitis due to apical abscess of right maxillary molar which was visualised on orthopantomogram. Case2: A 36/M presented with mild pre-septal cellulitis and lacrimal abscess. Case3: A 79/M presented with diminution of vision, pain and inability to move the right eye. He had history of watering for8 years. He was diagnosed to have orbital cellulitis with fistula secondary to acute on chronic dacryocystitis. Discussion: Case 1: Symptoms resolved spontaneously with emergency access opening of right first maxillary molar and systemic intravenous broad-spectrum antibiotics. She further underwent dacryocystectomy with fistulectomy. Case 2: Lacrimal abscess was managed with incision and drainage followed by dacryocystorhinostomy. Case 3: Orbital cellulitis was managed with broad-spectrum intravenous antibiotics. Dacryocystectomy with fistulectomy was performed after the eye was quiet. Conclusion: Presentation of dacryocystitis can have variable causes hence proper history and addressing underlying cause at the earliest can help in early resolution. Aggressive management of complications can help in steady subsidence without progression.

Qualitative and Quantitative Magnetic Resonance Imaging in Bacterial Orbital Cellulitis

ABSTRACT Purpose To summarise the qualitative and quantitative parameters of bacterial orbital cellulitis (OC) on magnetic resonance imaging (MRI) and explore their clinical correlations. Methods Multi-centre retrospective study with inclusion of patients of all ages with OC who underwent MRI. Patients with isolated pre-septal cellulitis, bilateral disease and poor-quality scans were excluded. An enlargement ratio for extraocular muscles (EOMs) was calculated by dividing maximal EOM measurements from the affected side by the contralateral side. Results Twenty MRI scans from twenty patients (Mean age: 40.8 ± 24.3 years old, M: F = 15:5) between 2011 and 2022 were analysed. Three (15.0%) cases were paediatric patients (<18 years old). All cases had both pre-septal and orbital fat involvement. The EOM were affected in nineteen cases, with the superior muscle complex (18/19, 94.7%) most commonly affected. Mean enlargement ratio (1.30, Range: 1.04–1.82) was greatest for the medial rectus on axial views on T1 and fat-suppressed contrast-enhanced T1 (FS CE T1). Optic peri-neuritis was present in eleven (55.0%) patients, whilst two (9.5%) cases had optic neuritis. A greater degree of proptosis was observed in patients with optic neuropathy and those who underwent surgical intervention compared to those without (p = .002 and p = .002, respectively). Conclusion MRI remains an important imaging modality for evaluating complicated OC. However, qualitative features may lack accuracy and is not a reproducible means of analysis. Simple quantitative parameters, such as proptosis and EOM measurements, correlate with high-risk clinical features and may have utility in predicting clinical course.

Diagnosis and Management of Orbital Cellulitis in a Reference Center in Senegal

The severity of orbital cellulitis is the risk of blindness and cerebro-meningeal complications that can be life-threatening. The objective of our study was to report the clinical, paraclinical, therapeutic and progressive aspects of orbital cellulitis. This was a retrospective, descriptive study over 5-year, from 1st January 2017 to December 31st 2021, in the ophthalmology department of Aristide le Dantec University Hospital. We glued 102 patients. The incidence was 32.8 cases per year. The average age was 23 years, the age group from 0 to 15 years was the most representative (49%). The most frequent reason for consultation was eyelid swelling (87%). There was a predominance of preseptal cellulitis (64%). An ORL etiology was found in 21.5% of cases. Orbital-cerebral CT was performed in 57 patients. It made this possible to classify cellulite and identify sinusitis in 21.6% of cases. All patients received antibiotics and corticosteroid therapy were combined 48 hours after the start of treatment in 41 patients. The evolution was favorable in 73.5% of cases. Ten patients (9.8%) presented a complication. We aim for 3 cases of blindness. Death occurred in a patient who presented a bilateral orbital cellulitis complicated by cavernous sinus thrombophlebitis. The prognosis depends on the delay in treatment, the stage of the disease and the existence of comorbidity factors.

A case series of patients with ophthalmic manifestations of monkeypox in Spain

Monkeypox virus (MPXV) is a zoonotic orthopox DNA virus presently causing a global outbreak. The mucosae are affected in 41% of the cases; the nasal and eye regions are the least affected (1%). The most frequent eye infection is conjunctivitis with severe cases of corneal affection leading to permanent visual sequelae. We describe two cases of patients presenting facial edema, erythema, and vesiculo-pustular lesions with confirmed positive MPXV DNA polymerase chain reaction (PCR). Preseptal cellulitis and MPXV infection were diagnosed and treated with antibiotics and tecovirimat. A third patient was admitted to the hospital with pain and redness of the right eye and vesiculo-pustular skin lesions. On ophthalmological examination, he was diagnosed with a corneal ulcer and a creamy white infiltrate and was treated with systemic tecovirimat and ciprofloxacin eye drops. Healthcare professionals should be familiar with ocular manifestations of MPXV infection and consult ophthalmologists to reduce the risk of potentially vision-threatening complications.

Management of oculo-orbital complications of odontogenic sinusitis in adults.

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.

Pediatric orbital lesions: non-neoplastic extraocular soft-tissue lesions.

Orbital pathologies can be broadly classified as ocular, extraocular soft-tissue (non-neoplastic and neoplastic), osseous, and traumatic. In this paper, we discuss the key imaging features and differential diagnoses of congenital and developmental lesions (dermoid cyst, dermolipoma), infective and inflammatory pathologies (pre-septal cellulitis, orbital cellulitis, optic neuritis, chalazion, thyroid ophthalmopathy, orbital pseudotumor), and non-neoplastic vascular anomalies (venous malformation, lymphatic malformation, carotid-cavernous fistula), emphasizing the key role of CT and MRI in the imaging work-up. In addition, we highlight the adjunctive role of ocular ultrasound in the diagnosis of dermoid cyst and chalazion, and discuss the primary role of ultrasound in the diagnosis of vascular malformations.

Particulars of sinogenic orbital complications in children

Sinogenic orbital complications in children are relatively rare but critical conditions that require accurate diagnosis and timely appropriate treatment to prevent severe sequelae. This article concentrates on clinical, diagnostic, and therapeutic specifics of sinogenic orbital complications in children. The work is based on aliterature review (PubMed, Google Scholar) and own experience as well as data from the authors' own pediatric population. In children, sinogenic orbital complications are usually secondary due to acute bacterial sinusitis. Correct distinction between pre- and postseptal cellulitis is of utmost importance for correct diagnostic and therapeutic management in order to prevent long-term sequelae. Preseptal cellulitis can be treated conservatively. If there are signs of postseptal involvement, prompt cross sectional imaging will be required. Depending on the severity of the postseptal involvement, surgical treatment may be necessary. Recent literature debates three main issues: 1)developing models for different combinations of symptoms that reliably distinguish between pre- and postseptal cellulitis; 2)selection of appropriate cross-sectional imaging (MRI vs. CT); and 3)indications for surgery. All three issues will be discussed in detail in this article.

Management of Streptococcus pyogenes Preseptal Cellulitis in Multisystem Inflammatory Syndrome in Children (MISC)

Introduction : Preseptal cellulitis were more common in children than adults. Preseptal cellulitis was an infection involving the anterior part of the orbita septum. Management of preseptal cellulitis, especially in children, were important to save visual function.&#x0D; Case Illustration : A boy, 1 year 8 months, was complained by his mother with swollen and redness on both eyes. The patient has a history of Multisystem Inflammatory Syndrome in Children (MISC) and Global Developmental Delay (GDD). Both eyes were edema, hyperemia, excoriation, bleeding, tenderness on eyelid, and conjunctival injection. Blood Culture examination results showed Streptococcus pyogenes bacteria. Patient was receiving therapy of antibiotics cefoperazone-sulbactam, amikacin, methylprednisolone intravena, enoxaparin subcutaneous injection, moxifloxacin and prednisolone asetat eye drops during hospitalization at Prof. Dr. I.G.N.G. Ngoerah General Hospital.&#x0D; Discussion : A patient with fever and respiratory tract infection was diagnosed with preseptal cellulitis. Preseptal cellulitis is a common infection of the eyelid and periorbita soft tissues characterized by acute eyelid erythema and edema. Antibiotic therapy had been started before blood culture examination. This study discusses toddler with preseptal cellulitis treated with antibiotics showing good results.&#x0D; ConclusionPreseptal cellulitis due tue multisystem inflammatory syndrome in children was an infection of the soft tissues of the eye that requires a multidisciplinary approach in management therapy. Early detection and adequate therapy have been proven to significantly improve patient survival rates and quality of life.

Ocular manifestations of acute myeloid leukemia during induction phase of chemotherapy: A case series

The aim of this series is to report diverse ocular features noted in patients during the induction phase in acute myeloid leukemia (AML). Three female patients undergoing induction therapy for AML reporting for various ocular complaints were examined. Detailed history, including the onset of AML and chemotherapy and any past ocular or systemic ailment, was taken. Best-corrected visual acuity, anterior segment, and posterior segment examinations were performed. Intraocular pressure was measured, and color vision was tested. Routine hematological, and biochemical investigations and imaging were done when required. Patients with abnormal parameters were referred to an oncologist for management. A varied spectrum of ocular manifestations was noted in these three female patients, including preseptal cellulitis, orbital cellulitis, and subhyaloid hemorrhages. Immediate treatment was given to patients with vision-threatening conditions in consultation with an oncologist and otorhinolaryngologist, and patients responded well to the treatment. Owing to its cytoreductive action, AML induction therapy exposes the patient to various adverse events, causing significant ocular and systemic morbidity. All the diagnosed patients of AML are recommended to undergo a baseline ocular assessment.

Ixodes tick infestation presenting as preseptal cellulitis: A rare occurrence

Herein, we report a case of preseptal cellulitis due to an Ixodes tick infestation, which was subsequently treated by mechanical removal and antibiotics. A 50-year-old man presented to the ophthalmology clinic with gradually increasing swelling of both upper and lower lids of his right eye with associated watering. He was diagnosed with unilateral preseptal cellulitis with a grayish nodule near the lower eyelid, which was found to be a hard tick of the Ixodes genus. Complete removal of the tick with the help of a blunt forceps under local anesthetic cover was performed. A prophylactic course of oral antibiotics was also prescribed to the patient. After a period of 1 week, all his symptoms had subsided without any systemic manifestations. Ticks are acarine ectoparasitic hematophagies, many species of which have been recognized as vectors of lethal pathogens. Tick infestation of the ocular tissue is a rare occurrence. Complete removal of the tick parts is pertinent to prevent the late sequelae and serious complications. This case report suggests that clinicians should be aware about tick bite–related sequelae, such as preseptal cellulitis and other complications, to reach an early diagnosis.

Pediatric preseptal and orbital cellulitis – a 6 year experience from a London tertiary centre

ABSTRACT Purpose This study reports the experience of pediatric preseptal and orbital cellulitis at a London tertiary centre during a 6-year period and highlights the role of orbital surgeons in the management of subperiosteal abscess (SPA). Methods A retrospective review was conducted of all pediatric patients hospitalised for preseptal and orbital cellulitis. Results A total of 201 children including 152 cases of preseptal cellulitis and 49 cases of orbital cellulitis were admitted at a London tertiary centre over the study period. Patients with orbital cellulitis and especially those managed surgically had higher rates of fever, higher presenting white cell count and C-reactive protein level compared to cases of preseptal cellulitis. 77.6% of patients with orbital cellulitis had SPA. 81.6% of SPA had a medial component, while 28.9% had superior component. 61.2% of orbital cellulitis cases were managed surgically. Surgical intervention was carried out by otorhinolaryngologists (ENT) in 76.7% of cases, jointly between ENT and orbital surgeons in 16.7% of cases and by orbital surgeons alone in 6.7% of cases. Of the 11 SPA involving the orbital roof, all were surgically managed and orbital surgeons were involved in 54.5% of cases. When SPA involved the medial wall, orbital surgeons were only involved in 6.5% of cases. Conclusions We recommend all patients with superior SPA be treated at a centre with both ENT and orbital surgeons as these may not be amenable to drainage by ENT alone.

Role of Acute Rhinosinusitis in Periorbital Infections in Children

ObjectivePeriorbital cellulitis in children are commonly caused by acute rhinosinusitis (ARS). This study investigated the association of ARS and the severity of periorbital cellulitis in children. Study designRetrospective case-control study of children with periorbital cellulitis with ARS versus periorbital cellulitis without ARS. SettingPatients were seen at West Virginia University Children's Hospitals between August 2011 to August 2022. MethodsPatients were divided into cases and controls based on presence or absence of ARS. ARS was defined based on clinical symptoms with objective presence of disease on CT scan. Patients’ characteristics, treatment, hospital length of stay, and readmission were collected. ResultsThe sample consisted of 118 pediatric patients with orbital cellulitis. Patients with ARS were younger than patients without ARS (6.3 vs 8.5, p = 0.025), however there were no sex differences between two groups (p = 0.540). The ARS group had higher incidence of postseptal cellulitis (51.5% vs 9.6%, p < 0.001). As compared to patients without ARS, patients with ARS were more likely to be admitted (p < 0.001), have a longer length of stay (median of 3.5 days vs 0.5 days, p < 0.001), require IV antibiotics (95.3% vs 54.9%, p < 0.001), and require surgical intervention (23.1% vs 5.8%, p < 0.001). Readmission rate was similar between the two groups. ConclusionChildren presenting with acute periorbital cellulitis who have ARS tend to have more severe infection requiring higher level of care. ARS should be assessed and incorporated into the plan of care of pediatric patients with periorbital infections.