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laceration Blepharophimosis Myasthenia gravis Multiple sclerosis Blepharochalasis Giant cell arteritis Preseptalcellulitis Globe malposition Benign essential blepharospasm (BEB) Third nerve palsy Horner's syndrome Transection of levator muscle or aponeurosis Orbital and facial fracture Contributors Authors Milan Eye Center Oculoplastic Surgery Johns Creek GA Disclosures KS declares that he has no competing interests. Professor of Ophthalmology Illinois Eye and Ear Infirmary University of Illinois (...) , acquired aponeurotic and involutional ptosis in downgaze From the collection of Dr Allen Putterman [Citation ends]. Differentials Involutional changes Prolapsed orbital fat Dermatochalasis Congenital myogenic ptosis Thyroid eye disease Previous eye-related surgery or implant Chalazion Stye (hordeolum) Uveitis Orbital cellulitis Orbital inflammatory syndrome Eyelid tumours Orbital tumours Chronic progressive external ophthalmoplegia (CPEO) Cerebrovascular accident (CVA) Eyelid foreign body Eyelid
not provide sufficient anatomical coverage for evaluation for complications. In addition, potential complications such as orbital or preseptal/periorbital cellulitis, subperiosteal abscess, or subdural/epidural collections are inadequately visualized and may be missed in the absence of IV contrast administration. Therefore CT with IV contrast of the sinuses to include the orbits and brain is recommended [23,65]. A reported benefit of contrast-enhanced CT for detection of sinusitis-related complications (...) that suggest intracranial complications include Pott puffy tumor, altered consciousness, seizures, hemiparesis, and cranial nerve palsy [19-23]. Ethmoid sinusitis can lead to spread of infection through the lamina papyracea, a thin bone that separates the medial orbital wall from the ethmoid sinuses . Manifestations of orbital involvement include medial orbital wall subperiosteal abscess, periorbital cellulitis, and ocular findings (eg, abnormal visual examination, ophthalmoplegia, or proptosis
and six had ocular stinging, with conjunctivitis in three for over 2 weeks. Antibiotics were needed in three, for preseptalcellulitis in two of them. Nine patients discontin- ued imiquimod due to ocular irritation and conjunctivitis, of whom four patients recommenced and ?nished the treatment after a rest period. At a mean follow-up of 16 weeks, 34 (72%) patients had clinical clearance of the periocular lesions and no patient had any residual ophthalmic side-effects from imiquimod. There is no good
Isolated left upper eyelid ptosis with pansinusitis and contralateral otitis media in a 9-year-old boy Upper eyelid ptosis has different etiologies in children and adults. In children, the common causes include orbital cellulitis, congenital ptosis, Cranial Nerve (CN) III palsy, and Horner's syndrome. The purpose of this report is to discuss an unusual presentation of ptosis.We describe a case of a 9-year-old boy with left-sided ptosis with no apparent clinical signs of orbital or preseptal
antibiotics in hospital No difference in the rate of line infections associated with home administration. Brugha, 2012 5 Children with preseptalcellulitis n = 63 IV antibiotics administered on an ambulatory basis IV antibiotics in hospital No difference in duration of treatment or rate of complications between groups. Collaco, 2010 6 Patients with cystic fibrosis n = 1,535 IV antibiotics at home IV antibiotics in hospital • Long term decline in FEV1 observed in both groups. • No difference in time (...) events: a retrospective cohort study. Eur J Clin Microbiol Infect Dis. 2012 Oct;31(10):2611-9. PubMed: PM22526869 5. Brugha RE, Abrahamson E. Ambulatory intravenous antibiotic therapy for children with preseptalcellulitis. Pediatr Emerg Care. 2012 Mar;28(3):226-8. PubMed: PM22344208 6. Collaco JM, Green DM, Cutting GR, Naughton KM, Mogayzel PJ Jr. Location and duration of treatment of cystic fibrosis respiratory exacerbations do not affect outcomes. Am J Respir Crit Care Med [Internet]. 2010 Nov 1
Paediatric orbital and periorbital infections. This study is a review of recent literature in the diagnosis and management of preseptalcellulitis, orbital cellulitis and dacryocystitis, including causative organisms, diagnosis and medical or surgical therapy and potential complications.Advances in vaccination against Haemophilus influenzae B have resulted in a shift in the most common causative organisms of preseptal and orbital cellulitis. Management of orbital cellulitis has been advanced (...) by adjuvant corticosteroids, and subperiosteal abscess volumes of more than 1250 ml has been shown as predictive for requiring potential surgical intervention.Periorbital infections require prompt evaluation and management. Although the infectious organisms in both preseptal and orbital cellulitis include Staphylococcus/Streptococcus species, management may differ significantly on the basis of the nidus of infection, presenting signs and symptoms, and response to initial medical management.
. The majority of the previously operated patients (61%) had some form of orbital wall dehiscence noted on imaging. Preseptalcellulitis was the most common complication (61.5%) encountered, followed by orbital cellulitis (23%), sub-periosteal abscess (11.5%), orbital abscess (3%), and cavernous sinus thrombosis (1.5%). Gram-positive bacteria were more commonly isolated from acute rhinosinusitis patients and gram-negative bacteria from chronic rhinosinusitis (CRS) patients. Complete recovery was noted in all (...) in patients with preseptal and orbital cellulitis. In more advanced stages, surgical drainage is advocated with excellent results. Larger cohort studies are needed to further investigate this patient group.
of red eye, some of which are serious or sight-threatening and require same day assessment by ophthalmology — for further information, see the CKS topic on . The differential diagnosis for allergic conjunctivitis includes: Serious conditions such as: Acute glaucoma. Episcleritis and scleritis. Keratitis. Iritis/uveitis. Corneal ulcer, abrasion or foreign body. Preseptal or preorbital cellulitis. Other types of conjunctivitis such as: Infective conjunctivitis — may be caused by viruses, bacteria (...) or unreactive pupils. Visual acuity (using a Snellen chart) and visual fields. Compare to previous levels of visual acuity, if possible. Eyelids – look for discharge, swelling, inflammation, malposition, nodules, loss of lashes (may indicate sebaceous gland carcinoma), vesicles (herpes), lice infestation or blepharitis. Periorbital area — look for swelling and erythema which may indicate orbital or periorbital cellulitis. Periorbital cellulitis can develop from conjunctivitis in young children. A dull blue
manifestations of multiple myeloma.Our patient's presentation was associated with a throbbing frontal headache, nasal congestion, malaise, and weight loss. Differential diagnosis on admission included giant cell arteritis, conjunctivitis, preseptalcellulitis, glaucoma, acute sinusitis, or cavernous sinus thrombosis. Extensive ophthalmologic evaluation did not show any intraocular abnormality. However, a magnetic resonance imaging of the brain showed hyperintense foci in the right frontal calvarium leading
and child CHU Mohamed VI, Marrakech over a period of six years (January 2011-October 2017). Patients underwent cranio-orbital CT scan. The average age of patients was 5 years, with a slight female predominance. The disease mainly involved the sinus (22 patients). The analysis of computed tomography results highlighted 37 cases of preseptalcellulitis (66%), 3 cases of isolated retroseptal cellulitis (5%), 16 cases of mixed cellulitis (28%), 8 cases of exophthalmia (14%) and 4 cases of subperiosteal (...) Imagerie de la cellulite orbitaire chez lâ€™enfant: Ã propos de 56 cas Orbital cellulitis is rare but potentially severe in children. Diagnosis is primarily based on clinical examination and imaging (CT or MRI). This study aims to highlight the role of imaging, in particular CT scan, in the diagnosis and in the treatment of this pathology. We conducted a retrospective study of 56 cases of orbital cellulitis, whose data were collected in the Department of Radiology at the Hospital mother
during a 27-year period.We retrospectively reviewed the medical records of all patients with orbital complications of paranasal sinusitis hospitalized at the National Cheng Kung University Hospital, a medical center in Taiwan during 1988-2015. Sex, age, symptoms, history, ophthalmological findings, laboratory and imaging findings, treatments, and outcomes were analyzed by staging.Eighty-three patients aged 9 days to 80 years had stage I (preseptalcellulitis, n = 39 patients), II (postseptal orbital (...) cellulitis, n = 8), III (subperiosteal abscess, n = 16), IV (orbital abscess, n = 8), or V (intracranial involvement, n = 12) complications. Peak incidences occurred in patients aged 0-19 and 60-69 years. Chronic sinusitis and diabetes mellitus were common preexisting diseases. Extraocular movement limitation and proptosis predicted postseptal (stage II or more) involvement. The likelihood of elevated intraocular pressure increased with stage. Reduced visual acuity and presence of relative afferent
Things Are Not Always What They Seem: Two Cases of Child Maltreatment Presenting With Common Pediatric Chief Complaints. We describe 2 cases of child maltreatment who presented as common pediatric conditions: preseptalcellulitis and gastroenteritis. The first case is an 8-year-old girl who presented with progressive right eye pain, swelling, and discharge. She was initially treated for preseptalcellulitis, but eye cultures ultimately grew Neisseria gonorrhoeae. Further investigation revealed
secondary to congestion within the ethmoid sinuses. Alternative terms for sympathetic effusion (inflammatory edema) are preseptal or periorbital cellulitis. The remaining “true” orbital complications are best visualized by contrast-enhanced CT scanning. Intracranial complications of acute sinusitis, which are substantially less common than orbital complications, are more serious, with higher morbidity and mortality than those involving the orbit. Intracranial complications should be suspected (...) , especially if accompanied by proptosis or impaired function of the extraocular muscles. Orbital complications of acute sinusitis have been divided into 5 categories: sympathetic effusion, subperiosteal abscess, orbital cellulitis, orbital abscess, and cavernous sinus thrombosis. Although sympathetic effusion (inflammatory edema) is categorized as an orbital complication, the site of infection remains confined to the sinus cavities; eye swelling is attributable to the impedance of venous drainage
features, laboratory and radiology results, treatment modalities, and the response to these treatments.Thirty-six patients (21 males, 15 females) with an average age of 71.43±42.24 months (5-168 months) participated in the study in the two-year period. Thirty-two patients (88.9%) had preseptalcellulitis, and four (11.9%) had orbital cellulitis. All patients had eyelid hyperemia, edema, and ocular pain, with chemosis in seven and proptosis in four cases. Twenty-five patients were admitted with fever (...) . All cases were unilateral and 44.4% occurred secondary to paranasal sinusitis. All cases were treated with intravenous cefazolin-amikacin. The mean of duration of hospitalization was 12.02±8.75 days (range, 3-28 days) and the duration of parental antibiotics was 12.83±8.18 days (range, 7-21 days). All patients recovered without any vision loss, only one patient experienced subdural empyema complicating preseptal cellulitis.Most orbital tissue infections occur secondary to paranasal sinusitis
and to analyse the factors affecting it.A prospective interventional study was designed and infants presenting with acute dacryocystitis with or without complications like dacryocystopyocele/ lacrimal abscess/preseptalcellulitis at a Tertiary Eye Care Centre from May 2014 to April 2016 were enrolled. Demographic details and baseline clinical characteristics were noted. Intravenous antibiotics were started and probing under general anaesthesia was done. Follow up was done after one month. Success was defined (...) as subsidence of acute attack and resolution of epiphora at final follow up of one month.A total 20 eyes of 18 patients were included with male: female ratio 10:8. Mean age of patients was 6.5 months and the mean duration of symptoms was 5.6 days. Dacryocystitis with lacrimal swelling was present in five eyes, preseptalcellulitis was present in two eyes while the rest 13 eyes presented with simple inflammation over the lacrimal sac. After one month, 85% (17eyes) had complete resolution of symptoms
etiology was acute frontal sinusitis (62%), followed by a history of chronic rhinosinusitis (28%). Two patients presented with concomitant preseptalcellulitis and cutaneous fistula each, while another had pneumocephalus. The majority of cases (59%) had Draf 1 procedure. Three cases had Draf 3 procedure. Five cases were successfully treated by sinus balloon sinuplasty. Postoperatively, most patients had either oral or intravenous antibiotics of varying duration. There were no further complications
providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders. Competing interests declared for this topic: None. References References Benton,J. and Karkanevatos,A. ( 2007 ) Preseptalcellulitis due to Mycobacterium marinum. Journal of Laryngology & Otology. 121 ( 6 ), 606 - 608 (...) by infection of an eyelash follicle or associated gland, or Internal — occurs on the conjunctival surface of the eyelid, caused by infection of a meibomian gland. Styes are generally self-limiting, and most resolve within 5–7 days. Styes are common in people with blepharitis and recurrence is common if any underlying blepharitis is not adequately managed. Rarely, infection may spread to neighbouring tissues, which can lead to periorbital cellulitis. A persistent internal stye can develop into a meibomian
Hereditary angioedema type 2 presented as an orbital complication of acute rhinosinusitis. Hereditary angioedema is an autosomal dominant and life-threatening disorder characterized by recurrent episodes of non-pitting edema affecting the skin, respiratory system and digestive tracts and caused by a congenital deficiency or function defect of the C1 esterase inhibitor. Preseptalcellulitis is defined as an infection of the tissues of the anterior orbital septum. It is generally caused
of stay, type of complication and cost of care were determined for these patients.The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average
Periorbital Dirofilariasis: A Rare Case from Western India Dirofilariasis is a zoonotic disease caused commonly by Dirofilaria repens and Dirofilaria immitus. The definitive hosts are domestic dogs and cats. Human beings are accidental dead end hosts, and acquire infestation through mosquito bites. So far, very few cases have been reported from western India. We report a case of a 27-year-old male who presented with preseptalcellulitis right eye and a firm mass in the lower lid (...) . Histopathological examination after surgical excision of the mass revealed a diagnosis of dirofilariasis. Although rare in Western India a diagnosis of dirofilariasis should be considered in cases of preseptalcellulitis associated with a periorbital mass.