PURPOSE: To report upon several cases of rhino-orbito-cerebral mucormycosis with variable clinical manifestations including ocular symptoms. METHODS: We documented three patients with rhino-orbital-cerebral mucormycosis and uncontrolled diabetes. RESULTS: The patients presented variable ophthalmic symptoms including blepharoptosis, ophthalmoplegia, visual disturbance, visual field defect and ocular pain. Despite administration of an antifungal agent within two days, all of the patients died. CONCLUSIONS: We reported the cases of three patients with rhino-orbito-cerebral mucormycosis presenting ophthalmic symptoms with a literature review. Variable initial symptoms were emphasized in making diagnosis of rhino-orbito-cerebral mucormycosis.
Blepharoptosis ; Diagnosis ; Humans ; Mucormycosis* ; Ophthalmoplegia ; Orbital Cellulitis ; Visual Fields

BACKGROUND AND OBJECTIVES: Acute sinusitis is a mild, self-limiting disease. In children, however, sinusitis may lead to other severe, even life-threatening, conditions. Therefore, appropriate diagnosis and management are needed. Orbital complications from sinusitis are caused by expansion through natural suture lines, foramen, dehiscence of lamina bone and bony erosion due to acute infection and necrosis. The purpose of this study was to analyze the common types of orbital complications and to compare the symptoms, prognoses and treatments of children and of adults, respectively. Materials and Method: Twenty-one children under15 years of age and thirteen adults over 15 were enrolled in the study. Symptoms, durations of treatment, treatment modalities, prognoses, and CT findings were analyzed. RESULTS: Preseptal cellulitis was found in 6 children (28.6%) and 8 adults (61.5%) ; subperiosteal abscess in 9 children (42.9%) and 3 adults (23.1%) ; and orbital cellulitis in 6 children (28.6%) and 2 adults (15.4%). Eye lid swelling was found in all subjects, while diplopia and limitation of eye movement was found in 4 children (19%) and 2 adults (15.4%). Medical treatment was the first line of therapy for both children (76.2%) and adults (61.5%), with the remaining children (23.8%) and adults (38.5%) receiving surgical treatment. CONCLUSION: While generally more severe, orbital complications in children can be treated more conservatively than those arising in adults.
Abscess ; Adult ; Cellulitis ; Child ; Diagnosis ; Diplopia ; Eye Movements ; Humans ; Necrosis ; Orbit* ; Orbital Cellulitis ; Prognosis ; Sinusitis* ; Sutures

PURPOSE: The present study reviews the clinical features of orbital cellulitis in childhood for early diagnosis and proper treatment. METHODS: The authors performed a retrospective study by computed tomography (CT) on children under 14 years of age diagnosed with orbital cellulitis and admitted to Pusan National University Hospital from 2003 to 2010. RESULTS: In total, 27 patients were identified (range 4 months to 14 years). Periorbital swelling was the most common initiating symptom, followed by fever and conjunctival injection. Paranasal sinus disease was the most common predisposing factor. Preseptal cellulitis was the most common finding, followed by subperiosteal abscess, orbital cellulitis, and orbital abscess. All patients underwent a blood culture; none were positive. Intravenous antibiotics therapy was performed empirically and was effective in all cases. No patients suffered from permanent complications except recurrence. CONCLUSIONS: Orbital cellulitis in children presents with periorbital swelling, fever, conjunctival injection in association with sinusitis, and upper respiratory infection (URI). A CT study is a reliable diagnostic option for the early detection and localization in the pediatric orbital cellulitis. Early empirical antibiotic therapy is mandatory for successful treatment.
Abscess ; Anti-Bacterial Agents ; Cellulitis ; Child ; Early Diagnosis ; Fever ; Humans ; Orbit ; Orbital Cellulitis ; Paranasal Sinus Diseases ; Retrospective Studies ; Sinusitis

Endogenous endophthalmitis is rare, but when it occurs, there is high probability of visual loss in spite of early diagnosis and treatment. But in many patients, it is difficult to find exact primary site, and even if there is a presumed site, it is difficult to disclose causative organisms. As a result, proper antibiotic treatmaent may not be carried out in some cases. In a 55 year old man who suffered from liver abscess, we experienced a case of endogenous endophthalmitis accompanied by severe orbital cellulitis caused by klebsiella pneumoniae from liver abscess, and ocular symptom improved after identification of pathogen and antibiotic administration. However visual loss could not be prevented. So, we first report this case with a review of available literatures and remind seriousness of this disease at the same time.
Early Diagnosis ; Endophthalmitis* ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess* ; Liver* ; Middle Aged ; Orbit* ; Orbital Cellulitis*

PURPOSE: A diagnosis of wooden intraorbital foreign bodies is common and their removal is often necessitated after complications become manifested. In case of operation, it is difficult to find and remove wooden foreign bodies completely. We have experienced a case of retained multiple intraorbital foreign bodies removed by the secondary operation. We report this case with a literature review. METHODS: A 39-year-old man visited our clinic complaining of diplopia, exophthalmos, and limitation of eyeball movement. He had fallen down and had a lacerated wound. Right after primary closure, he experienced strabismus, orbital cellulitis, and abscess. Several months later, he had a soft mass in the operated lower lid, and two wooden intraorbital foreign bodies were found. MRI detected granuloma and cellulitis near the cavernous sinus. RESULTS: More than ten intraorbital wooden foreign bodies were surgically removed. After the surgery exophthalmos and diplopia were improved, and limitation of eyeball movement disappeared. The MRI findings were also improved. CONCLUSIONS: Intraorbital wooden foreign bodies should be diagnosed with a thorough history taking and radiologic exam, due to a number of potential complications, such as orbital cellulitis, abscess, and diplopia. Furthermore, they should be removed in consideration that they can move spontaneously into the deep interior of the orbit.
Abscess ; Adult ; Cavernous Sinus ; Cellulitis ; Diagnosis ; Diplopia ; Exophthalmos ; Foreign Bodies* ; Granuloma ; Humans ; Magnetic Resonance Imaging ; Orbit ; Orbital Cellulitis ; Strabismus ; Wounds and Injuries

PURPOSE: To report a case of delayed orbital cellulitis with subperiosteal abscess after orbital floor fracture repair using an absorbable sheet implant (Macropore®, Medtronic Inc., Minneapolis, MN, USA). CASE SUMMARY: A 16-year-old male visited the oculoplastic clinic for left eye pain, lower eyelid swelling and vertical diplopia for 1 day. The patient had a history of inferior orbital wall fracture repair surgery using Macropore® 20 months prior. The orbital computed tomography scan showed a subperiosteal cystic mass with surrounding infiltration at the left orbital floor, and ethmoidal and maxillary sinusitis; however, sheet implant was not clearly observed. Despite systemic antibiotic treatment for 3 days, his clinical findings did not improve, thus we decided to drain the subperiosteal abscess through a transconjunctival approach. Intraoperatively, the Macropore® sheet was almost dissolved, but small pieces remained. The culture of drained contents showed no microorganisms. Systemic antibiotics were continued for 18 days after surgery, and clinical symptoms completely improved. CONCLUSIONS: Delayed orbital cellulitis should be considered in patients with extraocular muscle movement limitation and painful orbital swelling if the patient has a history of orbital wall fracture repair, even if a bioresorbable implant was used. Prompt imaging evaluation should be emphasized for early diagnosis and proper treatment.
Abscess ; Absorbable Implants* ; Adolescent ; Anti-Bacterial Agents ; Diplopia ; Early Diagnosis ; Eye Pain ; Eyelids ; Humans ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Orbit* ; Orbital Cellulitis* ; Orbital Fractures

Orbital infarction syndrome is defined as ischemia of all intraorbital and intraocular structures and is a rare disorder due to rich anastomotic vascularization of the orbit. It results in orbital and ocular pain, total ophthalmoplegia, anterior and posterior segment ischemia, and acute bindness. It can occur secondary to different mechanisms such as acute perfusion failure, systemic vasculitis, orbital cellulitis and vasculitis. We experienced a case of orbital infarction syndrome in a 61-year-old nonketotic diabetic woman who had developed paranasal sinusitis by mucormycosis and presented orbital cellulitis, multiple nerve paralysis, chorioretinal ischemia, facial necrosis around orbit and acute blindness. Prompt recognition of clinical pictures and rapid diagnosis is essential for early treatment of orbital infarction due to rhino-orbitocerebral mucormycosis because its progression is very rapid and fatal.
Blindness ; Diagnosis ; Female ; Humans ; Infarction* ; Ischemia ; Middle Aged ; Mucormycosis* ; Necrosis ; Ophthalmoplegia ; Orbit* ; Orbital Cellulitis ; Paralysis ; Perfusion ; Sinusitis ; Systemic Vasculitis ; Vasculitis

Orbital infarction syndrome is defined as ischemia of all intraorbital and intraocular structures and is a rare disorder due to rich anastomotic vascularization of the orbit. It results in orbital and ocular pain, total ophthalmoplegia, anterior and posterior segment ischemia, and acute bindness. It can occur secondary to different mechanisms such as acute perfusion failure, systemic vasculitis, orbital cellulitis and vasculitis. We experienced a case of orbital infarction syndrome in a 61-year-old nonketotic diabetic woman who had developed paranasal sinusitis by mucormycosis and presented orbital cellulitis, multiple nerve paralysis, chorioretinal ischemia, facial necrosis around orbit and acute blindness. Prompt recognition of clinical pictures and rapid diagnosis is essential for early treatment of orbital infarction due to rhino-orbitocerebral mucormycosis because its progression is very rapid and fatal.
Blindness ; Diagnosis ; Female ; Humans ; Infarction* ; Ischemia ; Middle Aged ; Mucormycosis* ; Necrosis ; Ophthalmoplegia ; Orbit* ; Orbital Cellulitis ; Paralysis ; Perfusion ; Sinusitis ; Systemic Vasculitis ; Vasculitis

No abstract available.
Humans ; Laser Therapy/methods ; Magnetic Resonance Imaging ; Male ; Orbital Cellulitis/*complications/diagnosis ; Retinal Vein Occlusion/diagnosis/*etiology/surgery ; Tomography, X-Ray Computed ; Young Adult

Acute maxillary sinusitis is a common disorder affecting children. Untreated acute sinusitis can develop into chronic sinusitis, and complications, such as orbital cellulitis or abscess, can occur. Maxillary sinusitis of odontogenic origin is not a well-recognized condition and is frequently missed in children. As an odontogenic source of sinusitis, the dentigerous cyst is one of the most prevalent types of odontogenic cysts, and it is associated with the crown of an unerupted or developing tooth. This report concerns a nine-year-old boy who was diagnosed with maxillary sinusitis originating from a dentigerous cyst with supernumerary teeth. The boy visited our pediatric clinic presenting with rhinorrhea and nasal obstruction and was initially diagnosed with maxillary sinusitis only. With antibiotic treatment, his symptoms seemed to improve, but after 2 months, he came to our clinic with left facial swelling with persistent rhinorrhea and nasal obstruction. Radiographic examinations of the sinuses were performed, and he was diagnosed with maxillary sinusitis originating from a dentigerous cyst with supernumerary teeth. After a surgical procedure involving the removal of the dentigerous cyst with supernumerary teeth, the symptoms of sinusitis gradually diminished. There are only very few cases in the pediatric medical literature that remind us that odontogenic origin can cause maxillary sinusitis in children. Our patient can act as a reminder to general pediatricians to include dentigerous cysts in the differential diagnosis of maxillary sinusitis.
Abscess ; Child* ; Crowns ; Dentigerous Cyst* ; Diagnosis, Differential ; Humans ; Male ; Maxillary Sinus* ; Maxillary Sinusitis* ; Nasal Obstruction ; Odontogenic Cysts ; Orbital Cellulitis ; Sinusitis ; Tooth ; Tooth, Supernumerary*