Signs Of Orbital Cellulitis Research Articles

Outcomes of Treating a late case of Herpes Zoster Ophthalmicus masquerading as Orbital Cellulitis: A Case Report

Abstract
 Introduction : Herpes zoster ophthalmicus (HZO) refers to a reactivated varicella-zoster virus involving the V1 nerve division. Although rare, previous reports have mentioned HZO cases masquerading as orbital cellulitis (HZO-OC). This report depicts the use of acyclovir, corticosteroids and citicoline in our HZO-OC patient with treatment delay.
 Case Illustration : A healthy 66 year old man presented to our clinic 4 weeks after signs of orbital cellulitis followed by vesicular rash following the CN V(1) dermatome were felt which was untreated. The right palpebra was edematous and erythematous. Hazy cornea, mixed injection, grade IV reverse RAPD, diminished direct and consensual reflex and external ophthalmoplegia of the right eye were noted. The diagnosis of HZO-OC with multiple cranial neuropathies OD was established. Topical and symptomatic treatment were given resulting no improvement. Ptosis of the right palpebra became present. The patient was then given systemic acyclovir, methylprednisolone and citicoline. Ophthalmoplegia improved after 2 months and ptosis improved after 4 months.
 Discussion : The use of systemic acyclovir and corticosteroids in HZO-OC patients were given promptly in previous literature. Multiple cranial nerve in our patient was thought to occur due to treatment delay. As improvement was not noted after topical treatment, these systemic treatments along with citicoline were added. Citicoline was added due to its ability to promote neural regeneration.
 Conclusion : Systemic acyclovir, corticosteroids and citicoline may still be beneficial for HZO-OC patients with delayed treatment.

Meningo-encephalo-vasculitis, optic neuritis, and thrombotic complications: About a fulminant mucormycosis in a diabetic patient

Mucormycosis is a destructive, potentially fatal, and opportunistic fungal infection caused by filamentous Mucorales which commonly affect immunocompromised hosts. This infection might take different forms such as gastrointestinal, pulmonary, cutaneous or even a disseminated form, yet the rhinocerebral localization is historically the primary presentation of the disease and most common type. It originates in the nasal mucosa owing to fungal inoculation, then it spreads through paranasal sinuses and orbits to the brain and its vessels especially the cavernous sinus, leading to thrombotic complications including arterial thrombosis. Herein, we present a case of a 35-year-old male with poorly controlled diabetes who presented with decompensated diabetes, in whom the clinical examination finds subtle signs of orbital cellulitis. The patient subsequently had worsening necrotizing orbital cellulitis which required surgical drainage of the left ethmoid along with large spectrum antibiotic therapy; this was complicated by the development of meningo-encephalo-vasculitis as well as cavernous sinus and left internal carotid thrombosis. Tissue cultures revealed evidence of Rhizopus.

Fungal orbital cellulitis presenting as a discharging fistula

We present a very rare case of fungal orbital cellulitis which presented to us as a pus-discharging fistula below the medial canthus. The patient presented with signs of orbital cellulitis along with a pus-discharging fistula below the medial canthus with positive mucopurulent discharge from the puncta and fistula on syringing. It started with swelling near the medial canthus. The patient responded well on broad-spectrum antibiotics but developed a necrotic patch on the hard palate. The Magnetic resonance imaging (MRI) showed intraconal and extraconal involvement. Diagnostic nasal endoscopy (DNE) was done and the tissue was sent for Potassium hydroxide (KOH) mounting, culture, and histopathology. After the KOH mount showed budding-like yeast cells, the patient was started on antifungals and discharged when the repeat culture report showed no growth. Therefore, a high level of suspicion should be maintained for a fungal cause even in the presence of the pus-discharging fistula.

To study the clinical course of rhino orbital mucormycosis in post COVID-19 patients: A case series

Rhino orbital cerebral mucormycosis is an opportunistic fungal infection with high morbidity and mortality which has seen the rise during the second wave of covid 19 in our country. Aim of our study was to study the clinical course, diagnosis and management of patient of rhino orbital mucormycosis in post covid phase presenting at our tertiary care centre. 4 cases of rhino-orbital mucormycosis who presented to us in post covid phase was followed and details recorded and analyzed to study its clinical course, diagnosis and management. 4 patients presented to us in post covid phase with signs of orbital cellulitis like periorbital swelling with pain, drooping of eyelids, proptosis, restriction of extraocular movements, decrease and loss of vision and sluggish reacting pupil. MRI/CT of the patients showed intraconal and extraconal involvement suggestive of orbital cellulitis. Diagnostic Nasal Endoscopy (DNE) was done and tissue sent for KOH mounting, culture and histopathology. After KOH mount showed fungal hyphae, patients were started on IV liposomal amphotericin B and retrobulbar amphotericin B. Patients were then taken up for endoscopic debridement and significant improvement in proptosis, ptosis, peribulbar swelling and pain was seen in immediate post op period. significant improvement was seen in patients with IV amphotericin B, retrobulbar amphotericin B and endoscopic debridement. Patients with rhino orbital mucormycosis can be managed with amphotericin and endoscopic debridement when exenteration is not possible.

A pediatric case of orbital cellulitis with pansinusitis and subperiosteal abscess

While less common than preseptal cellulitis, orbital cellulitis can have severe complications. With the proper use of a computed tomographic (CT) scan, physicians can more quickly recognize the clinical signs of orbital cellulitis and begin interventions to properly treat the condition. This case report highlights the importance of timely diagnosis and successful intervention for orbital cellulitis by recognizing infection progression.

Тромбоз кавернозного синуса, ассоциированный с COVID-19

This paper describes a case of cavernous sinus thrombosis The condition developed in a patient who had been treated for confirmed COVID-19 Left eye examination findings were as follows: amaurosis;absence of periorbital skin sensation;signs of orbital cellulitis;ptosis;chemosis;total ophthalmoplegia;exophthalmos;decreased corneal sensation;widened pupil;and absence of pupil light reflex In addition, ophthalmoscopy showed diffused retinal and optic disc edema The patient had an atypical clinical course which could not be clearly identified as septic or aseptic, and his elevated D-dimer level could indicate a potential relationship between this condition and COVID-19 © Oripov O I , Bilalov E N , 2021

SAT-490 A Case of Unilateral Exophthalmos Due to Thyroid Orbitopathy and Its Association with Chronic Kidney Disease

Graves ophthalmopathy(GO)is the most common extra-thyroidal manifestation of Graves’ disease (GD). Most cases of GO are bilateral which may be asymmetric, whereas unilateral ophthalmopathy is less common and has been observed in 9-15% cases. Association between chronic kidney disease and unilateral Grave’s ophthalmopathy in a clinically euthyroid patient is rare. We report a case of a 24-year-old male with no previous history of any chronic medical illnesses who presented with protruded right eye for the past 6 months. He did not have any other visual symptoms or symptoms related to thyroid disease. Laboratory results revealed low TSH, normal free T3 and free T4. TSH receptor antibodies were positive. He also had elevated serum creatinine at 418 umol/L (normal levels 64 - 110 umol/L). US KUB showed bilateral small sized kidneys and increased parenchymal echogenicity suggestive of chronic kidney disease. MRI Head showed features suggestive of unilateral thyroid associated orbitopathy. Patient received 1-week course of oral prednisolone 10 mg per day after which his exophthalmos improved.Case report: A 24 year old male with no previous history of any chronic medical illnesses, presented to the clinic with protruded right eye for the past 6 months that was progressively getting worse. There was no eye pain, visual changes, ophthalmoplegia, dryness or discharge from eye. Patient did not report any other symptoms, Physical examination revealed a comfortable man with protruded right eye, lid retraction, normal eye movements and no signs of orbital cellulitis. Neck examination was significant for a mild diffuse goitre. Laboratory studies were significant for haemoglobin of 12.1 g/dl (normal 13-17 g/dl). He also had elevated serum creatinine at 418 umol/L (normal 64 - 110 umol/L). Serum electrolytes, liver function tests and lipid profile were within normal range. 24 hr urine collection showed 3.08 gm/24 hr proteinuria. Serum TSH was 0.04 mIU/L (normal 0.45 - 4.5 mIU/L), free T4 was 13.8 pmol/L (normal 9 - 20 pmol/L) and free T3 was 4.56 pmol/L (normal 2.89 - 4.88 pmol/L). Thyrotropin Receptor Ab titre was 4.69 IU/L (normal 0.00 - 1.75 IU/L). ANA, ANCA, C3, C4, Anti thyroid peroxidase and Anti GBM antibodies were negative. Screening for hepatitis B, C and HIV was negative US KUB showed bilateral small sized kidneys and increased parenchymal echogenicity suggestive of CKD. MRI Head was remarkable for proptosis of the right eye with increased retro-orbital fat, thickening and T2 hyper-intensity with sparing of the tendinous insertion involving the right inferior, medial, superior and lateral rectus muscles with crowding at the orbital apex. Features were suggestive of unilateral thyroid associated orbitopathy. Patient received 1-week course of oral prednisolone 10 mg per day after which his exophthalmos improved. An association between CKD and GO in a clinically euthyroid patient is rare.

Retinoblastoma with autoinfarction presenting as orbital cellulitis

We describe a case of unilateral retinoblastoma in a 13-month-old boy who presented with signs of orbital cellulitis. Heterochromia, hyphema, and vitreous hemorrhage were observed. Initial computed tomography (CT) imaging failed to reveal the calcified intraocular mass that was later identified on ultrasonography. Histopathology of the enucleated eye revealed diffuse inflammation and tumor necrosis but with absence of malignant retinoblastoma cells. Genetic testing was equivocal. The patient is presumed to have had retinoblastoma that underwent autoinfarction, leading to secondary inflammation. This case highlights the importance of complete ocular evaluation and proper imaging modalities in children presenting with orbital cellulitis.

Orbital Cellulitis after Faden Operation on the Medial Rectus

Background Orbital cellulitis after strabismus surgery is uncommon, may cause blindness and may lead to death. Very few cases have been described in detail due to the low incidence of this complication. Methods We report the first case of orbital cellulitis following Faden operation on the medial rectus muscle. We believe that the infection was due to asymptomatic ethmoid sinusitis. Our case is compared with other cases previously reported. Results A two-year-old boy was surgically treated for residual esotropia after two botulinum toxin A injections. Two days after surgery, signs of orbital cellulitis developed in his right orbit. CT-scan disclosed right ethmoid sinusitis that spread to the orbit after surgery. After intravenous antibiotic treatment, the infection resolved with full restoration of visual acuity and ocular motility. Conclusion Despite adequate measures to prevent infection, orbital cellulitis may complicate strabismus surgery. Patients must be instructed to recognize early symptoms of this severe infection and call the surgeon immediately. Diagnosis may be confirmed by CT-scanning of the orbits. Prompt treatment with intravenous antibiotics usually leads to full recovery.

Orbital Complications After Aqueous Drainage Device Procedures

A retrospective case series of 2 patients with orbital complications after tube shunt placement for glaucoma is reported. The first patient presented with limited motility and conjunctival injection in the setting of intraocular gas leakage in the superior orbit after previous vitreoretinal surgery. The second patient presented with multiple signs of orbital cellulitis. Both patients improved with intravenous antibiotics. Although rare, orbital complications may occur after glaucoma tube shunt surgery.

Retinoblastoma Manifesting as Orbital Cellulitis

AbstractFive children with previously undiagnosed retinoblastoma had signs of unilateral orbital cellulitis and were treated with systemic antibiotics, corticosteroids, or both. When retinoblastoma was finally diagnosed clinically, radiologists believed in every case that, on the basis of the soft-tissue swelling seen with computed tomography, there was orbital extension of the tumor. However, intraoperative and histopathologic observations disclosed no demonstrable orbital tumor involvement. The affected eyes all had neovascular glaucoma, and all harbored highly necrotic tumors that were contained within the eye. We concluded that orbital inflammation can occur with retinoblastoma confined to the eye and that signs of orbital cellulitis do not necessarily imply orbital extension of the tumor.