Clinical analysis of orbital infectious diseases of 34 patients / 天津医药

@#Objective To discuss the etiology, clinical features, imaging manifestations, treatment principles and prognosis of the orbital infectious diseases. Methods Thirty-four patients with orbital infectious diseases hospitalized in Tianjin Medical University Eye Hospital from August 2011 to October 2017 were collected and retrospectively analyzed. We analyzed clinical data of patients including the etiologies, types of the infection, imaging manifestations, treatments and prognoses. Relsults There were 21 patients with orbital abscesses, 13 patients with orbital cellulitis only, no abscess formation. The main cause of the orbital infectious patients disease was related to paranasal sinusitis, others included furuncles of eyelid skin, dacryocystitis, trauma, entophthalmia, odontogenic infection, nosocomial infection and systemic diseases. Twenty-two cases were operated, and 12 cases were treated conservatively. Thirty (30/34) cases acquired well prognoses without serious complications, except 1 occurred central retinal artery and vein occlusion, and 3 were treated by ophthalmectomy and lost their visual function permanently. The CT imaging of orbital infectious diseases showed the swelling, increased density, diffuse inflammation and unclear boundaries of the involved tissues. The imaging of orbital abscesses showed that in addition to inflammation, the abscesses and the masses were obvious in the orbit. MR generally showed long T1 and long T2 signals. Conclusion There are many causes of orbital infectious diseases, and the course progresses rapidly. With the help of imaging examination, it can accurately locates the infection, and shows the type and range, and comprehensively evaluates the disease in combination with clinical features. Anti-infection and etiological therapy are crucial factors, if necessary, surgery and multiple department treatment should be combined to avoid serious complications.

Fungal infections of the orbit.

Fungal infections of the orbit can lead to grave complications. Although the primary site of inoculation of the infective organism is frequently the sinuses, the patients can initially present to the ophthalmologist with ocular signs and symptoms. Due to its varied and nonspecific clinical features, especially in the early stages, patients are frequently misdiagnosed and even treated with steroids which worsen the situation leading to dire consequences. Ophthalmologists should be familiar with the clinical spectrum of disease and the variable presentation of this infection, as early diagnosis and rapid institution of appropriate therapy are crucial elements in the management of this invasive sino‑orbital infection. In this review, relevant clinical, microbiological, and imaging findings are discussed along with the current consensus on local and systemic management. We review the recent literature and provide a comprehensive analysis. In the immunocompromised, as well as in healthy patients, a high index of suspicion must be maintained as delay in diagnosis of fungal pathology may lead to disfiguring morbidity or even mortality. Obtaining adequate diagnostic material for pathological and microbiological examination is critical. Newer methods of therapy, particularly oral voriconazole and topical amphotericin B, may be beneficial in selected patients.

Neonatal orbital abscess.

Orbital complications due to ethmoiditis are rare in neonates. A case of orbital abscess due to acute ethmoiditis in a 28‑day‑old girl is presented. A Successful outcome was achieved following antimicrobial therapy alone; spontaneous drainage of the abscess occurred from the lower lid without the need for surgery. From this case report, we intend to emphasize on eyelid retraction as a sign of neonatal orbital abscess, and to review all the available literature of similar cases.

Internal Carotid Artery Occlusion and Intracranial Abscess Associated with Sino-orbital Aspergillosis: Case Report

Authors described a case with intracranial abscess formation from sino-orbital aspergillosis. A 38-year-old woman presented with headache, facial pain, visual disturbance, and exophthalmus. Sino-orbital mass lesion, destruction of the skull base, and contiguous brain abscess were on coronal CT scan. Bacterial culture obtained from the initial operation directed to the brain abscess disclosed no organism. The final diagnosis of the aspergillosis was made from a biopsy of the mass in the ethmoid sinus. Cerebral angiogram showed complete occlusion of the ipsilateral carotid artery at 1cm proximal to the origin of the posterior communicating artery. The patient was treated with amphotericin B.