ABSTRACT
BACKGROUND: A high-pressure stream from mechanical equipment may inject gas or liquids deep into the orbit with few initial clinical signs. Aggressive surgical debridement as used in the extremities for the treatment of injection injuries is not possible in the orbit. METHODS: Four patients with orbital injection injuries from farm or industrial equipment are presented. Previously reported cases of high-pressure injection injury are reviewed. RESULTS: Two patients suffered localized anterior orbital inflammation partially responsive to steroidal and nonsteroidal anti-inflammatory agents. Late debridement was required in one patient for a persistent lipogranuloma. Two patients suffered more dramatic and diffuse injections of hydrocarbon mixtures, requiring emergent early surgical debridement and decompression for compressive orbital signs. All patients attained an adequate functional outcome, with one patient's vision limited by a coexisting ocular injury. CONCLUSIONS: High-pressure orbital injection injuries manifest a spectrum of signs ranging from acute inflammation with tissue necrosis and compressive visual loss to late chronic inflammation with a pseudotumor-like course. The authors recommend the initial treatment of orbital injection injuries with systemic antibiotics followed by prompt neuroradiologic imaging. Systemic corticosteroids should be added for confirmed injection injuries with surgical debridement of discrete masses and orbital decompression when indicated. Continued therapy with anti-inflammatory medication may be required to suppress chronic inflammation with selective late surgical debridement of lipogranulomas.
Subject(s)
Eye Foreign Bodies/etiology , Eye Injuries, Penetrating/etiology , Occupational Diseases/etiology , Orbit/injuries , Pressure/adverse effects , Adult , Endophthalmitis/diagnostic imaging , Endophthalmitis/drug therapy , Endophthalmitis/surgery , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/surgery , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/surgery , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Occupational Diseases/diagnosis , Occupational Diseases/surgery , Orbit/surgery , Tomography, X-Ray ComputedABSTRACT
A 65-year-old man underwent an uncomplicated extracapsular cataract extraction with placement of a posterior chamber intraocular lens. The patient developed delayed-onset chronic endophthalmitis caused by Nocardia asteroides. This was confirmed on multiple intraocular cultures, as well as histopathologic examination of the lens capsular bag. The patient was treated with periocular, intravitreal, and systemic antibiotic treatment, combined with intraocular lens removal, total capsulectomy, and three vitrectomies in an attempt to eradicate the organism and calm the eye. The patient went on to develop widespread endophthalmitis that required enucleation of the infected globe. To our knowledge, this is the first case of delayed-onset chronic endophthalmitis caused by N asteroides after extracapsular cataract extraction with a posterior chamber intraocular lens.
Subject(s)
Cataract Extraction , Endophthalmitis/microbiology , Eye Infections, Bacterial , Nocardia Infections , Nocardia asteroides , Postoperative Complications/microbiology , Aged , Anti-Bacterial Agents/therapeutic use , Chronic Disease , Endophthalmitis/drug therapy , Endophthalmitis/pathology , Eye Enucleation , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/pathology , Humans , Lens Capsule, Crystalline/surgery , Lenses, Intraocular , Male , Nocardia Infections/drug therapy , Nocardia Infections/pathology , Nocardia asteroides/isolation & purificationABSTRACT
Phacoemulsification combined with pars plana vitrectomy was performed on seven patients with both cataracts and vitreoretinal disease. Six of the seven had a posterior chamber intraocular lens (PC-IOL) placed in the capsular bag following cataract extraction. Visual acuities ranging from light perception to hand movement preoperatively, postoperatively ranged from hand movement to 20/25. There were no perioperative complications. During an average follow-up of more than 6 months, neovascular glaucoma developed in one patient, and a conjunctival cyst in another. The PC-IOLs were well tolerated. The small limbal incision used in phacoemulsification allows better control during the vitrectomy procedure and ensures a water-tight wound. In addition, with the limbal approach, the posterior lens capsule is maintained, with all the attendant advantages.
Subject(s)
Cataract Extraction , Retinal Diseases/surgery , Vitrectomy , Adult , Aged , Combined Modality Therapy , Eye Diseases/surgery , Female , Follow-Up Studies , Humans , Lenses, Intraocular , Male , Middle Aged , Postoperative Complications , Visual AcuityABSTRACT
We studied the clinical and histopathologic features of Pneumocystis carinii choroiditis in three patients with acquired immunodeficiency syndrome. In two cases, a provisional diagnosis of disseminated P. carinii infection was made by ophthalmologic examination. The characteristic fundus changes in this infection consisted of numerous slightly elevated, plaque-like, yellow-white lesions located in the choroid and unassociated with signs of intraocular inflammation. The diagnosis was confirmed by postmortem examination of the eyes and other organs. Histopathologically, the globes showed many choroidal infiltrates that were eosinophilic, acellular, vacuolated, and frothy. Several such infiltrates were noted within the choroidal vessels and choriocapillaries. Gomori's methenamine silver stain demonstrated many cystic and crescentic organisms. Electron microscopy disclosed thick-walled cystic organisms and large numbers of trophozoites.
