Severe Eyelid Edema Research Articles

Shingles without hutchinson sign developing herpes zoster ophthalmicus and preseptal cellulitis

A previously healthy 69-year-old man presented to an emergency room with a vesicular rash on his right forehead in line with shingles (herpes zoster) secondary to varicella-zoster virus. The patient was negative for the Hutchinson sign, a rash involving the tip of the nose or nasal ridge, which indicates an increased risk of herpes zoster ophthalmicus (HZO). Only around 10-20% of shingles cases develop HZO, which is an emergent vision-threatening disease [1]. The patient reports history of chickenpox and denies any immunocompromising conditions [2]. He was sent home on a course of oral valaciclovir. Four days later he was brought to the emergency room with an enlarged, crusting rash encompassing the right side of his forehead to the eyelid with blurry vision and severe eyelid edema (Figure 1A). The rash was spread along the ophthalmic distribution of the trigeminal nerve completely within the V1 dermatome, indicating HZO.

Chemotherapy-induced exacerbations of thyroid orbitopathy in a patient with B-cell lymphoma

ABSTRACTA 55-year-old woman with concurrent active thyroid orbitopathy and B-cell lymphoma developed acute exacerbation of thyroid orbitopathy after receiving Rituximab, cyclophosphamide, hydroxydaunorubicin, Prednisone (R-CHOP) chemotherapy, presenting with subtotal loss of vision and severe eyelid edema. Intravenous methylprednisolone was fully effective within several hours. Further exacerbations of her orbitopathy were seen following every subsequent chemotherapeutic treatment, but responded well to oral prednisone. This case shows that thyroid orbitopathy may severely and acutely progress after chemotherapy for concurrent B-cell lymphoma. Clinical awareness of this potential complication may prevent blindness in this rare subset of patients.

Oral steroid therapy as an adjuvant treatment for severe epidemic keratoconjunctivitis in patients younger than 3 years.

To evaluate the therapeutic effect of oral steroids given to patients younger than 3 years with epidemic keratoconjunctivitis (EKC) accompanied by severe eyelid edema and inflammatory ptosis, in whom eye drops were not feasible. This study included 9 patients treated for EKC in local clinics whose condition failed to improve due to severe eyelid swelling together with difficulties in application of eye drops and pseudomembrane removal. We analyzed the extent of eyelid swelling, corneal damage, follicles, chemosis, and pseudomembrane formation in these patients before and after oral corticosteroid therapy in collaboration with the pediatrics department. After a mean of 1.8 ± 0.7 days of oral steroid treatment, eyelid edema, corneal damage, conjunctival injection, follicles, and chemosis improved in all patients. Oral steroids are an effective adjuvant treatment for EKC in patients younger than 3 years in whom eye drops could not be administered frequently due to severe eyelid edema.

Original papers: Electrocautery paraplical incision for Faden operation

In case of Faden operation (Cüppers' operation) without recession of the muscle, the authors looked for a direct approach to the site where the posterior fixation sutures should be placed. They chose a paraplical incision. To prevent bleeding they used electrocautery following a surgical technique previously described. The authors performed electrocautery paraplical incision in 270 eyes of 238 patients (age ranged between 3 y and 55 y). Follow-up time was 2.4 y + 1.3. After electrocautery, preparation of the medial rectus muscle and Faden procedure (without disinsertion of the muscle) were carried out. Finally the conjunctiva was closed with single sutures. In no patient did long-term complications occur and only the following minor complications were observed intra- or perioperatively: in one patient orbital fat protruded during surgery. Postoperatively one eye had a corneal erosion and another severe eyelid edema. In another patient a swollen plica with consecutive putrid secretion was observed. In all three cases symptoms disappeared after therapy. Paraplical incision was even possible after previous strabismus surgery with limbal incision. In Faden operation without recession of the medial rectus muscle, electrocautery paraplical incision is an alternative method with minimal postoperative inflammation and minimal scarring. It allows good approach to the medial rectus muscle, with minimal intraoperative bleeding. Postoperative healing and cosmesis are good.

Differentiation of Orbital Cellulitis From Preseptal Cellulitis by Computed Tomography

Computed tomography (CT) was used in the management of four patients with periorbital inflammation. These patients were selected for CT scanning because of the difficulty, on clinical examination alone, in determining the degree of orbital disease. The CT scans confirmed the presence and defined the location of an orbital abscess in three patients and eliminated the presence of an abscess in the fourth. On the basis of this experience, CT scanning is recommended in the evaluation of children with periorbital inflammation in whom proptosis, ophthalmoplegia, or loss of visual acuity develops, or in whom severe eyelid edema prevents adequate eye examination.