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Infection-Associated Ocular Cranial Nerve Palsies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Hardeep Singh Malhotra, Imran Rizvi, Neeraj Kumar, Kiran Preet Malhotra, Gaurav Kumar, Manoj K. Goyal, Manish Modi, Ravindra Kumar Garg, Vivek Lal
Extension of infection usually occurs through the paranasal sinuses (approximately 60–70% in adult patients) either though contiguous spread due to the thin lamina papyracea or by causing septic thrombophlebitis of connecting valve-less veins. Hematogenous spread may also be seen. Posterior extension of these infections may cause orbital apex syndrome and cavernous sinus thrombosis. Orbital trauma, nasolacrimal, or dental infections and procedures should always be borne in mind. Fever and leukocytosis are common in the pediatric age group. Clinically, presence of eyelid swelling with or without erythema, conjunctival chemosis, ophthalmoparesis, and proptosis with painful eye movement helps to consider a diagnosis of orbital cellulitis. Involvement and inflammation of optic nerve may cause diminution of visual acuity and optic disc edema. Eye is usually tender to touch, but tenderness and erythema are usually lesser as compared to periorbital cellulitis (Figure 16.10) (15).
Botulinum toxin complications and management
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Orbital cellulitis will present with localised oedema and erythema in the soft tissues surrounding the eye similar to periorbital cellulitis. Key discriminating factors which should make you consider orbital cellulitis as a likely diagnosis is proptosis, ophthalmoplegia, decreased visual acuity (and colour vision) and painful eye movements. In severe cases, patients may have a relative afferent pupillary defect or present with symptoms of stroke or encephalitis. Should a patient present with any of these symptoms, also take the time to take a full set of observations including their neurological status. Please note, following botulinum toxin therapy, should a patient present with an isolated ophthalmoplegia, then this may be due to misadministration of toxin as opposed to an underlying infection.
Ophthalmic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
There is generalized malaise, and a red, warm, oedematous or discharging eye. Orbital cellulitis also causes limited or painful eye movements, reduced vision and proptosis.Adjacent sinuses are tender when associated with the infection.
MRSA Decolonization and the Eye: A Potential New Tool for Ophthalmologists
Published in Seminars in Ophthalmology, 2022
Jeremy B Hatcher, Alex de Castro-Abeger, Richard W LaRue, Melanie Hingorani, Louise Mawn, Sean P Donahue, Paul Sternberg, Christine Shieh
Many MRSA infections involve the ocular surface (e.g., conjunctivitis, blepharitis). They can be relatively mild and resolve with appropriate treatment.3 However, MRSA infections also have the potential to become more severe and lead to permanent visual damage. MRSA is an important cause of preseptal and orbital cellulitis, acute or chronic dacryocystitis, as well as lacrimal and orbital abscesses.3,6,7 Orbital cellulitis, especially, may have a severe clinical course with potentially devastating consequences, including loss of the eye. Post-operative pediatric MRSA infection following strabismus surgery, while rare, has been correlated with orbital cellulitis and poor visual outcome.8,9 Other studies outside of ophthalmology indicate that while the average MRSA colonization rate in children is 1.5%, MRSA colonization climbs to around 76% if there is a prior history of MRSA skin or soft tissue infection.10,11 Additionally, MRSA infections have been implicated directly or indirectly in poor post-operative outcomes in anterior segment surgery.2,3 For example, MRSA blebitis and endophthalmitis have been reported after glaucoma surgery.12
Superior ophthalmic vein thrombosis: A rare complication of Graves’ orbitopathy
Published in Orbit, 2018
Dante Sorrentino, Kenneth J Taubenslag, Lance M Bodily, Katherine Duncan, Tonya Stefko, Jenny Y Yu
Optimal treatment for SOVT remains subject to debate. However, intervention should depend, at least partially, on etiology. Orbital cellulitis necessitates antibiotic therapy. If an orbital inflammatory syndrome is diagnosed, corticosteroids should be considered. In the setting of hypercoagulable state, anticoagulation is logical option in the absence of contraindication.2 Because of the rarity of SOVT, the utility of anticoagulation has not been established by large-scale study or randomized trial and discussion of anticoagulation in the literature applies primarily to cases with extension of thrombosis to the cavernous sinus. Still, anticoagulation is almost always a reasonable therapeutic option, though it was not pursued in the present case beyond basic venous thromboembolism prophylaxis. We elected for definitive surgical decompression in this case for several reasons. As a current smoker with a known history of non-adherence to follow-up, as well as SOVT and exposure keratopathy, her prognosis without aggressive multimodal therapy was poor. Simultaneous total thyroidectomy was performed to reduce her risk of recurrent eye disease.
Hyaluronidase allergy mimicking orbital cellulitis
Published in Orbit, 2018
Nirav D. Raichura, Md Shahid Alam, V. V. Jaichandran, Saurabh Mistry, Bipasha Mukherjee
Orbital inflammation following intraocular surgery can be due to orbital cellulitis or allergic orbital inflammation.7 Proptosis seen immediately following peribulbar injection may be due to retrobulbar hemorrhage. Allergy to hyaluronidase is uncommon; and available literature mainly consists of isolated case reports. Acute infective orbital cellulitis after intraocular surgery is a nightmare for any surgeon as it can be a threat to not just vision but also life. Hence, patients presenting with signs of orbital inflammation are usually treated as orbital cellulitis, unless proven otherwise, with intravenous antibiotics. Orbital inflammation due to either infection or allergy often presents with similar clinical features such as acute proptosis, chemosis, and restriction of ocular motility. However, infective orbital cellulitis patients, in addition, may also show decrease in vision, pupillary involvement, severe pain, raised temperature, and comorbidities such as sinusitis, diabetes, or immunosuppression.11 If untreated, infective cellulitis usually rapidly deteriorates both systemically and visually with infection spreading to cavernous sinus and meninges. Radiologically, it is difficult to differentiate the two entities as both conditions show signs of inflammation such as retrobulbar fat stranding, proptosis, and periorbital soft tissue edema. MRI is a better imaging modality of choice in suspected orbital abscesses and orbital apex or cavernous sinus involvement (in patients showing features of optic nerve dysfunction)12(Table 2).