MyMedR

Chidambaram VA, Anita CSY, Robert C, Garry C

Med J Malaysia, 2018 12;73(6):415-417.

IgG4-related disease is a newly described systemic autoimmune and allergic disease, characterized histologically by a fibroinflammatory response with IgG4 plasma cells. It was initially described as affecting the pancreas, but commonly involves the head and neck region as well. While a biopsy is essential for definitive diagnosis, cross sectional imaging may be the initial modality which may suggest this entity. We describe a case of pathologically proven IgG4 related disease which highlights some key radiologic features seen in this entity. Our case highlights some key radiological features of IgG4- related disease in the head and neck, with involvement of the lacrimal glands, pituitary gland and cranial nerves on CT.

Matched MeSH terms: Orbital Diseases/diagnosis*; Orbital Diseases/etiology; Orbital Diseases/pathology

Bilateral orbital cellulitis due to Neisseria gonorrhoeae and Staphylococcus aureus: a previously unreported case

Raja NS, Singh NN

J Med Microbiol, 2005 Jun;54(Pt 6):609-611.

PMID: 15888472 DOI: 10.1099/jmm.0.46031-0

Cellulitis of the orbit is a common cause of proptosis in children, and also frequently arises in the elderly and the immunocompromised. The condition is characterized by infection and swelling of the soft tissues lining the eye socket, pushing the eye ball outwards and causing severe pain, redness, discharge of pus and some degree of blurred vision. There is a small risk of infection spreading to the meninges of the brain and causing meningitis. This paper reports the case of an adult in whom polymicrobial bilateral orbital cellulitis had developed due to Staphylococcus aureus and Neisseria gonorrhoeae infection. N. gonorrhoeae infections are acquired by sexual contact. Although the infection may disseminate to a variety of tissues, it usually affects the mucous membranes of the urethra in males and the endocervix and urethra in females. To the authors' knowledge this is the first report of polymicrobial bilateral orbital cellulitis due to S. aureus and N. gonorrhoeae in medical literature.

Matched MeSH terms: Orbital Diseases/complications; Orbital Diseases/diagnosis; Orbital Diseases/microbiology*

Ocular myasthenia gravis and idiopathic orbital inflammatory disease: double the trouble!

Sharudin SN, Govindasamy G, Mohamad NF, Kanesalingam R, Vasudevan SK

Can J Ophthalmol, 2018 04;53(2):e55-e58.

PMID: 29631841 DOI: 10.1016/j.jcjo.2017.07.024

Matched MeSH terms: Orbital Diseases/diagnosis; Orbital Diseases/etiology*; Orbital Diseases/physiopathology

Pediatric subperiosteal orbital abscess secondary to acute sinusitis: a 5-year review

Tan VES

Am J Otolaryngol, 2011 Jan-Feb;32(1):62-8.

PMID: 20031268 DOI: 10.1016/j.amjoto.2009.10.002

Objective: Subperiosteal orbital abscesses (SPOAs) secondary to acute sinusitis are rare occurrences in the pediatric age group, more so in the neonatal period. Here, a rare case of SPOA in a 38-day-old newborn later drained via endoscopic sinus surgery is included also. This review describes the demographic data, clinical history, treatment, microbiology results, complications, and outcome.
Methods: The admission records for all the patients who were admitted to the Pediatric Surgical Ward in Sarawak General Hospital, Kuching, Malaysia, between January 2004 and May 2009 were retrospectively reviewed. Records of patients who presented with preseptal cellulitis, orbital cellulitis, subperiosteal abscess (extraconal), orbital abscess (intraconal), and cavernous sinus thrombosis were closely studied. Ophthalmology consultations were obtained in all these cases. Ultimately, 3 patients having SPOA secondary to acute sinusitis were selected for this review.
Results: All patients were male with rapid onset of periorbital signs, absence of purulent rhinorrhea, and presence of significant thrombocytosis (exceeding 500 × 109/L). The 38-day-old newborn had mixed infection of methicillin-resistant coagulase-negative Staphylococcus bacteremia and local Acinetobacter eye infection with Staphylococcus aureus in the SPOA. All had medially located SPOA that was adequately drained via endoscopic sinus surgery, resulting in full recovery.
Conclusion: Newborns with preexisting risk factors and immature immunity are at risk of severe and rare infections. Contrast-enhanced paranasal sinus computed tomographic scan is mandatory and reliable to differentiate preseptal and postseptal orbital infection, as both conditions can present similarly and rapidly deteriorate. In the contrast-enhanced computed tomography–demonstrable SPOA, endoscopic sinus surgery drainage of the abscess proved to be safe and reliable as the main treatment modality. All patients recovered well without complications.

Matched MeSH terms: Orbital Diseases/diagnosis; Orbital Diseases/etiology*; Orbital Diseases/microbiology; Orbital Diseases/therapy

Central vein stenosis: a rare cause of orbital congestion in a haemodialysis patient

Zahari KM, Mohamad Hatta NS, Ain Masnon N, Ch'ng LS

BMJ Case Rep, 2023 Aug 29;16(8).

PMID: 37643820 DOI: 10.1136/bcr-2023-254999

We report a rare, potentially sight-threatening ocular complication due to central venous stenosis related to a previous site of haemodialysis catheter. A dialysis-dependent woman in her 60s presented with left eye redness for 1 month followed by a remarkably prominent vessel on the left upper eyelid for 2 weeks. Examinations found left eyelid oedema with prominent venous dilatation on the upper eyelid as well as left eye mild proptosis, conjunctiva injection with corkscrew vessels, raised intraocular pressure, and dilated and tortuous retina vessels. Central thoracic venogram showed total occlusion on the left brachiocephalic vein with retrograde reflux to the jugular vein. An endovascular percutaneous transluminal balloon angioplasty was performed for the left brachiocephalic vein stenosis, which resolved the orbital, facial and neck venous congestion. The patient remained asymptomatic after 1 year.

Matched MeSH terms: Orbital Diseases*

Tissue Interleukin-17 and Interleukin-23 as Biomarkers for Orbital Granulomatosis with Polyangiitis

Isa H, Luthert P, Rose G, Verity D, Pusey C, Tomkins-Netzer O, et al.

Ophthalmology, 2015 Oct;122(10):2140-2.

PMID: 26116342 DOI: 10.1016/j.ophtha.2015.04.016

Matched MeSH terms: Orbital Diseases/diagnosis*; Orbital Diseases/metabolism

Orbital abscess due to acute ethmoiditis in a neonate

Reddy SC, Sharma HS, Mazidah AS, Darnal HK, Mahayidin M

Int J Pediatr Otorhinolaryngol, 1999 Jun 15;49(1):81-6.

PMID: 10428409

Orbital complications due to ethmoiditis are not uncommon in children. However, they are very rare in infants. A case of orbital abscess due to acute ethmoiditis in a 10 days old boy is reported. Causative microorganisms isolated from the operated specimen were Staphylococcus aureus and aspergillosis. Successful outcome was achieved following antimicrobial therapy, external ethmoidectomy, and surgical drainage of the abscess. The aetiopathogenesis and management of this clinical entity is discussed, with a brief review of the literature.

Matched MeSH terms: Orbital Diseases/diagnosis; Orbital Diseases/microbiology*

The epidemiology of Open Globe Injuries presenting to a tertiary referral eye hospital in Australia

Beshay N, Keay L, Dunn H, Kamalden TA, Hoskin AK, Watson SL

Injury, 2017 Jul;48(7):1348-1354.

PMID: 28438416 DOI: 10.1016/j.injury.2017.04.035

BACKGROUND: Open globe injuries (OGIs) account for 44% of the cost of ocular trauma within Australia. It is estimated that 90% of ocular trauma is preventable. However, there have been few epidemiological studies within Australia that have identified groups at risk of OGIs specifically. The aim of our study was to review the epidemiology of OGIs presenting to a tertiary referral eye hospital in Australia.

METHODS: The Birmingham Eye Trauma Terminology (BETT) system was used to classify injuries as globe ruptures, penetrating eye injuries (PEIs), intraocular foreign bodies (IOFBs) or perforating injuries. Demographic data, past ocular history, mechanism of trauma, ocular injuries, and best-corrected visual acuity (BCVA) before and after treatment were recorded.

RESULTS: The 205 OGIs included 80 globe ruptures, 71 PEIs, 48 IOFBs and six perforating injuries. Falls predominated in older age groups compared to the other mechanisms of injury (p<0.0001). A fall was responsible for 33 globe ruptures and 82% of these had a history of previous intraocular surgery. Globe rupture and perforating injuries had poorer visual outcomes (p<0.05), consistent with previous studies. Alcohol was implicated in 20 cases of OGI, with 11 of these due to assault. PEIs and IOFBs commonly occurred while working with metal. BCVA was significantly worse following removal of an intraocular foreign body. We found presenting BCVA to be a good predictor of BCVA at the time of discharge.

CONCLUSIONS: The causes of OGI varied in association with age, with older people mostly incurring their OGI through falls and younger adults through assault and working with metal. Globe ruptures occurring after a fall often had a history of intraocular surgery. The initial BCVA is useful for non-ophthalmologists who are unfamiliar with the ocular trauma score to help predict the BCVA following treatment.

Matched MeSH terms: Orbital Diseases/epidemiology*; Orbital Diseases/physiopathology

Fulltext Rhino-orbito-cerebral mucormycosis in an immunocompetent patient: case report and review of literature

Shatriah I, Mohd-Amin N, Tuan-Jaafar TN, Khanna RK, Yunus R, Madhavan M

Middle East Afr J Ophthalmol, 2012 Apr-Jun;19(2):258-61.

PMID: 22623872 DOI: 10.4103/0974-9233.95269

Rhino-orbito-cerebral mucormycosis is a fungal infection that can be fatal especially in immunocompromised patients. It is extremely rare in immunocompetent individuals. We describe here an immunocompetent patient who survived rhino-orbito-cerebral mucormycosis due to Saksenaea vasiformis, and provide a literature review of this rare entity.

Matched MeSH terms: Orbital Diseases/complications; Orbital Diseases/diagnosis*; Orbital Diseases/microbiology

Clinical and Imaging Features of Lacrimal Gland Involvement in Granulomatosis with Polyangiitis

Tan LT, Davagnanam I, Isa H, Rose GE, Verity DH, Pusey CD, et al.

Ophthalmology, 2015 Oct;122(10):2125-9.

PMID: 26233627 DOI: 10.1016/j.ophtha.2015.06.026

Lacrimal gland involvement in granulomatosis with polyangiitis (GPA) commonly accompanies orbital disease, but occasionally may be the sole presentation preceding any other organ manifestation or systemic disease. Diagnosis of orbital GPA, especially in patients with lacrimal involvement as the initial presentation, can be difficult because of nonspecific clinical features and lack of diagnostic specificity on histologic and antineutrophilic cytoplasmic antibody (ANCA) testing. Orbital GPA can be associated with a high morbidity from potential visual loss or rapid progression of latent systemic disease, making early diagnosis important. The purpose of this study was to describe the clinical and imaging features of patients with lacrimal gland involvement secondary to GPA and to compare them with those of other orbital inflammatory conditions in the lacrimal gland fossa.

Matched MeSH terms: Orbital Diseases/etiology; Orbital Diseases/pathology; Orbital Diseases/radiography

Fulltext Periorbital oedema after dental extraction: a case study

Lim JL

Aust Fam Physician, 2014 Aug;43(8):543-4.

PMID: 25114991

Keywords: Dental extraction; Periorbital oedema; Quiz

Matched MeSH terms: Orbital Diseases/etiology*

Fulltext A ten year retrospective review of orbital complications secondary to acute sinusitis in children

Suhaili DN, Goh BS, Gendeh BS

Med J Malaysia, 2010 Mar;65(1):49-52.

PMID: 21265249 MyJurnal

Acute sinusitis is most often a mild self-limiting disease. However, it may progress into severe and life threatening complications. One of the commonest being orbital complication of which visual loss is a direct consequence. In this 10 year retrospective study, the nature of orbital complication, clinical presentation and treatment modalities and outcome seen in children with acute sinusitis in a tertiary referral institute were reviewed. Of six patients, there was a case of preseptal cellulitis, 4 cases of subperiosteal abscess and one case of orbital abscess. Periorbital swelling was a common presenting feature. In 5 cases this was associated with proptosis with one case of impending optic nerve compression. The value of computed tomography and opthalmological examination as a component in the management plan is highlighted. All patients were treated with intravenous antibiotics but evidence of abscess collection warranted urgent surgical drainage in 5 patients, 3 being endoscopic drainage while external approach was done for the remaining 2 patients. Thus a child exhibiting orbital complication of acute sinusitis, prompt diagnosis and treatment is essential in obtaining the best outcome for the child.

Matched MeSH terms: Orbital Diseases/etiology*

Orbital apex syndrome due to trigeminal perineural spread of sinonasal leprosy: a case report

El Beltagi AH, El-Nil H, Alrabiah L, El Shammari N

Clin Imaging, 2012 Mar-Apr;36(2):142-5.

PMID: 22370135 DOI: 10.1016/j.clinimag.2011.07.004

Leprosy is a granulomatous disease primarily affecting the skin and peripheral nerves caused by Mycobacterium leprae, but also significantly involving sinonasal cavities and cranial nerves. It continues to be a significant public health problem, and despite multidrug therapy, it can still cause significant morbidity. The awareness of cranial nerve, intracranial and orbital apex involvement as in our case is important for appropriate treatment measures.

Matched MeSH terms: Orbital Diseases/diagnosis; Orbital Diseases/microbiology*

Clinical and imaging features predictive of orbital granulomatosis with polyangiitis and the risk of systemic involvement

Tan LT, Davagnanam I, Isa H, Taylor SR, Rose GE, Verity DH, et al.

Ophthalmology, 2014 Jun;121(6):1304-9.

PMID: 24560566 DOI: 10.1016/j.ophtha.2013.12.003

Granulomatosis with polyangiitis (GPA), previously Wegener's granulomatosis, requires prompt diagnosis and systemic review to exclude life-threatening disease. However, early diagnosis of orbital GPA may be difficult because anti-neutrophil cytoplasmic antibody (ANCA) and anti-PR3 antibody screening can be negative at presentation and orbital biopsies taken for diagnosis may not show the classic features of GPA. This study was designed to compare GPA with other causes of orbital inflammation and to identify the presenting clinical and imaging features most likely to predict GPA and its systemic spread.

Matched MeSH terms: Orbital Diseases/diagnosis*

Fulltext Rhino-orbito-cerebral mucormycosis: a treatment dilemma

Jeevanan J, Gendeh BS, Faridah HA, Vikneswaran T

Med J Malaysia, 2006 Mar;61(1):106-8.

PMID: 16708746 MyJurnal

A case of rhino-orbito-cerebral mucormycosis is presented showing its aggressive nature and progression of disease. The typical clinical features, neuroimaging and histological findings are highlighted in this report. Amphotericin B and surgical debridement remain the mainstay of treatment. However, associated co-morbidities need to be addressed.

Matched MeSH terms: Orbital Diseases/microbiology

Fulltext Invasive rhinocerebral mucormycosis with orbital extension in poorly- controlled diabetes mellitus

Hadzri MH, Azarisman SM, Fauzi AR, Kahairi A

Singapore Med J, 2009 Mar;50(3):e107-9.

PMID: 19352553

Rhinocerebral mucormycosis is an invasive fungal sinusitis with a high mortality rate, especially in immunocompromised patients. A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye. Computed tomography of the brain and orbits showed the extensive involvement of bilateral intranasal sinuses, orbits, extraocular muscle and soft tissues. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Despite the extensive mucormycosis invasion, she was successfully treated with intranasal and systemic amphotericin B and minimal adjunctive intranasal sphenoidotomy.

Matched MeSH terms: Orbital Diseases/microbiology*

Fulltext Posterior intraorbital metallic foreign body: a case discussion

Vinodh VP, Sellamuthu P, Harun RH, Zenian MS

Med J Malaysia, 2014 Apr;69(2):89-91.

PMID: 25241819 MyJurnal

Intraorbital foreign body (IOFB) has been a rare phenomenon in the cases of gunshot wounds and always represents a dilemma in medical management. In Sabah, this scenario is becoming common as there is still certain population in the interiors who owns self made guns for hunting. They either present with self inflicted gunshot injuries or after being mistakenly shot while hunting. There are very few articles on this topic especially when it is located posteriorly in the orbit and occurs without visual impairment. This case reports the challenges faced in the management of the patient with a posteriorly located metallic IOFB. The appropriate management of the patient is discussed based on several international literatures. Author describes a 37 years old male farmer, who was referred from a nearby district hospital after he sustained gunshot injuries to his face and scalp. Urgent computed tomography (CT) scan showed that bullet pellets were at the left orbital floor, the left mandible and the left frontal bone. All bullet pellets were located extracranially only without intracranial involvement. Patient clinically does not have any neurologic deficit and without any visual impairment, thus he refused any surgical intervention. As there is no proper guideline in managing such cases, decision was made based on evidences from international literatures. It was concluded that metallic IOFB located in the posterior orbit may be conservatively managed with observation and regular follow-ups as they are well-tolerated and does not cause much impact on visual deterioration unless inflammation, infection, optic neuropathy or functional deficit occurs. This avoids unnecessary surgery and prevents risk of iatrogenic injury to the eye.

Matched MeSH terms: Orbital Diseases

Herpes Zoster Ophthalmicus with Orbital Apex Syndrome-Difference in Outcomes and Literature Review

Lim JJ, Ong YM, Wan Zalina MZ, Choo MM

Ocul Immunol Inflamm, 2018;26(2):187-193.

PMID: 28622058 DOI: 10.1080/09273948.2017.1327604

Matched MeSH terms: Orbital Diseases/diagnosis*; Orbital Diseases/drug therapy; Orbital Diseases/virology

Fulltext Traumatic globe displacement into anterior cranial fossa

Patricia Ann John, Sylves Patrick, Mohtar Ibrahim, Adil Hussein

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):325-327.

MyJurnal

A 64-year-old Malay gentleman alleged occupational injury when a malfunctioned metal hydraulic door hit on his face while unloading sand from his tipper-truck. Post-trauma, he complained of right eye (RE) pain and total loss of vision. On examination, noted RE visual acuity was unable to be assessed and left eye (LE) was 6/24 with pinhole 6/9. No eyeball could be seen in the right socket with superior orbital rim step deformity and left periorbital haema- toma. Computed tomography scan of the brain and orbit confirmed displaced right eye globe into the right anterior cranial fossa with right and left multiple orbital wall fractures. He then underwent successful right eye globe reposi- tioning. Traumatic orbital roof fracture is a rare condition. Repositioning of the eye globe was done to salvage the eye globe for a cosmetic reason and to avoid localised inflammatory reaction at the anterior cranial fossa.

Matched MeSH terms: Orbital Diseases

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