Linfoma ocular primario vs celulitis orbitaria en tiempos de COVID-19 / Primary ocular lymphoma vs orbital cellulitis in times of COVID-19

Los tumores sólidos neoplásicos de tejido linfoide se caracterizan por proliferación acelerada de la porción linforreticular del sistema retículo endotelial, su incidencia mundial es de 4/100,000 prevalente en féminas entre 50-70 años, de etiología desconocida, asociado a helicobacter pylori, epstein barr y VIH. Clínicamente están presentes los síntomas B: fiebre, sudoraciones nocturnas, pérdida de peso, prurito y astenia. ausentes en el caso que nos ocupa de una paciente femenina de 46 años de edad que acudió a consulta de oftalmología por aumento de volumen a nivel de anejos de ojo izquierdo, proptosis indolora y disminución de la visión, con diagnóstico inicial de celulitis orbitaria tratada ambulatoriamente sin resolución. Se administró antibioticoterapia intravenosa sin mejoría clínica, se realizaron estudios complementarios de imagen radiológica, ultrasonido, resonancia magnética con evidencia de imagen tumoral de crecimiento antero lateral, desplazamiento de globo ocular, diámetro mayor de 57,3 mm, de características isointensas heterogéneas, secuencia T1 y flair, erosión de pared interna de orbita y la biopsia excisional informó linfoma primario de anexo ocular orbitario tipo no-Hodgkin. El abordaje acucioso con estudios complementarios para descartar neoplasias orbitarias en pacientes con celulitis orbitaria o dacriocistitis de evolución tórpida es necesario en todo momento, independiente de las condiciones atípicas de pandemia por COVID-19 que dificultan su manejo(AU)

Solid neoplastic tumors of lymphoid tissue are characterized by accelerated proliferation of the lymphoreticular portion of the reticulum endothelial system, their worldwide incidence is 4/100,000 prevalent in females between 50-70 years of age, of unknown etiology, associated with helicobacter pylori, epstein barr and HIV. Clinically, symptoms B are present: fever, night sweats, weight loss, itching and asthenia, absent in the present case of a 46-year-old female patient who came to the ophthalmology office due to increased volume at the level of the appendages. of the left eye, painless proptosis and decreased vision, with an initial diagnosis of orbital cellulitis treated outpatiently without resolution. Intravenous antibiotic therapy was administered without clinical improvement, complementary radiological imaging studies, ultrasound, magnetic resonance imaging were performed with evidence of an anterolateral growth tumor image, ocular globe displacement, diameter greater than 57.3 mm, heterogeneous isointense characteristics, T1 sequence and flair, erosion of the internal wall of the orbit and the excisional biopsy reported primary non-Hodgkin type orbital annex lymphoma. A careful approach with complementary studies to rule out orbital neoplasms in patients with orbital cellulitis or dacryocystitis of torpid evolution is necessary at all times, regardless of the atypical conditions of a COVID-19 pandemic that make its management difficult(AU)

Role of systemic corticosteroids in orbital cellulitis: a meta-analysis and literature review / Papel dos corticosteroides sistêmicos na celulite orbitária: uma metanálise e revisão da literatura ,

Abstract Introduction: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. Objective: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. Methods: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. Results: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD = −4.02 [−7.93; −0.12], p -value = 0.04, I2 = 96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR = 0.78 [0.27; 2.23], p -value = 0.64,I2 = 0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. Conclusion: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.

Resumo Introdução: O tratamento padrão da celulite orbitária inicia-se com uma combinação de antibióticos intravenosos de amplo espectro concomitante ao tratamento do seio comprometido. Objetivos: O objetivo deste estudo foi avaliar se a adição de corticosteroides poderia levar a uma resolução mais precoce da inflamação e melhorar o desfecho da doença. Método: Fizemos uma pesquisa independente em cinco bancos de dados (PubMed, SCOPUS, Embase, Web of Science e o banco de dados Cochrane) em busca de estudos publicados até dezembro de 2019. Dos estudos incluídos, revisamos a celulite orbitária e a morbidade da doença através dos períodos de internação, incidência de drenagem cirúrgica, edema periorbital, visão, níveis de proteína C-reativa e níveis séricos de leucócitos com foco na comparação do grupo tratado com esteroides e antibióticos e do grupo tratado apenas com antibióticos. Resultados: Os tempos de internação após a admissão dos diagnosticados com celulite orbitária (SMD = -4,02 [-7,93; -0,12], p-valor = 0,04, I2 = 96,9%) diminuíram no grupo tratado com esteroides e antibióticos em comparação ao grupo tratado apenas com antibióticos. A incidência de drenagem cirúrgica (OR = 0,78 [0,27; 2,23], p-valor = 0,64, I2 =0,0%) foi menor no grupo tratado com esteroides e antibióticos em comparação com o grupo tratado apenas com antibióticos. Conclusão: O uso de esteroides sistêmicos como adjuvante da antibioticoterapia sistêmica para celulite orbitária pode diminuir a inflamação orbitária com baixo risco de agravar a infecção. Com base em nossa análise, concluímos que o uso precoce de esteroides por um curto período pode ajudar a encurtar os dias de internação e prevenir a progressão da inflamação.

Cuerpo extraño intraorbitario extraído mediante abordaje pterional extradural / Intraorbial foreign body removed by extradural pterional approach

RESUMEN Paciente femenina de 9 años de edad, remitida al Hospital Pediátrico Universitario de Holguín "Octavio de la Concepción de la Pedraja", con el diagnóstico presuntivo de celulitis orbitaria izquierda. Se recoge el antecedente de trauma ocular ipsilateral con objeto de madera hacía un año, por lo que presentó como secuela disminución de la agudeza visual del ojo izquierdo. Al examen oftalmológico presentaba edema y secreciones purulentas a través de trayecto fistuloso en el párpado inferior. Se le realiza ecografía, tomografía computarizada e imagen por resonancia magnética de cráneo y órbitas, con sospecha de cuerpo extraño vegetal. Se decide realizar abordaje pterional extradural, y se logra la extracción de fragmento de madera. Cursa con tratamiento antibiótico con desaparición de las secreciones a las 48 horas del posoperatorio. La evolución ha sido favorable. Los traumas oculares son frecuentes, pero la presencia de cuerpos extraños intraorbitarios son eventos raros que desencadenan un proceso inflamatorio local, cuya magnitud estará en relación con la naturaleza de este. Los estudios imagenológicos son un elemento indispensable para el diagnóstico y la planificación quirúrgica(AU)

ABSTRACT A 9-year-old female patient is referred to Octavio de la Concepción de la Pedraja Children's University Hospital in Holguín with a presumptive diagnosis of left orbital cellulitis. The patient has an antecedent of ipsilateral ocular trauma by a wooden object one year before, which resulted in visual acuity reduction in the left eye. Ophthalmological examination revealed edema and purulent secretion along a fistulous tract in the lower eyelid. Suspicion of the presence of a plant foreign body leads to performance of echography, computed tomography and magnetic resonance imaging of the brain and orbits. It is decided to apply an extradural pterional approach and a wooden fragment is extracted. Antibiotic therapy is indicated and secretion disappears 48 hours after surgery. The patient's evolution has been favorable. Eye trauma is common, but the presence of intraorbital foreign bodies is a rare event that triggers a local inflammatory process whose magnitude will depend on its nature. Imaging studies are indispensable for diagnosis and surgical planning(AU)

Proptosis por Celulitis Orbitaria en paciente Pediátrico: reporte de un caso / Proptosis for Orbital Cellulitis in a Pediatric Patient: case report

Orbital cellulitis is an infectious disease that occurs most frequently in the pediatric age. The most common underlying factor for its development is ethmoidal sinusitis. The microorganisms associated with orbital infection are S. pneumoniae, S. aureus, H. influenzae and M. catarrhalis, whose therapeutic failure brings serious complications that include loss of vision, meningitis and intracranial infection. In the following case we want to capture the doctor's actions in this infectious pathology, the diagnoses we should rule out and antibiotic treatment. We report the case of a previously healthy 2-year-old male patient who consulted for an increase left bipalpebral volume, associated to impossibility of spontaneous opening of left eye and febrile peak of 39.4 ° C, with TAC of paranasal sinuses and orbit, where shows left medial intraorbital abscess, with preseptal compromise that determines left proptosis, deciding to start associated antibiotic therapy for orbital cellulitis with compromise preseptal. In view of the slow evolution, a study was started to rule out the associated tumor process, which is discarded, maintaining an antibiotic for 21 days with clinical improvement after these. Orbital cellulitis in the pediatric age should be diagnosed quickly and in a timely manner, since it is a medical emergency, it is a condition that requires hospitalization and management with systemic antibiotics.

Celulitis orbitaria secundaria a sinusitis. Presentación de un caso / Orbital cellulitis secondary to sinusitis. Case presentation

La celulitis orbitaria es la causa más frecuente de inflamación aguda de la órbita y constituye una urgencia oftalmológica relativamente frecuente y potencialmente grave en la población pediátrica. La inflamación puede extenderse a la región postseptal, y afectar el contenido de la órbita. La relación anatómica de la órbita con estructuras vecinas como los senos paranasales, es clave para entender la etiopatogenia de la enfermedad; aparece, en la mayoría de las ocasiones, como complicación de una sinusitis. Se presenta una paciente de cinco años de edad, con diagnóstico de celulitis orbitaria secundaria a una sinusitis. La descripción de las características clínicas de la enfermedad y su manejo en este caso, puede aportar información útil para el mejor abordaje de la entidad. Se concluye que los elementos fundamentales son el diagnóstico temprano y la atención multidisciplinaria.

Orbital cellulitis is the most frequent cause of acute swelling of the orbit and is a relatively frequent ophthalmological emergency and potentially serious in the pediatric population. The inflammation may extend to post septal region, and affect the orbit content. The anatomical relation of the orbit with their neighboring structures as paranasal sinuses is the key to understand the etiopathogenesis of the disease; a case of a five-year-old patient is presented, with a diagnosis of orbital cellulitis secondary to sinusitis. The description of the clinical characteristics of the disease and its management in this case, may offer useful information for a better approach of this entity. It is concluded that the main elements are early diagnosis and multidisciplinary evaluation.

Celulitis orbitaria complicada por absceso subperióstico debido a infección por Streptococcus pyogenes / Orbital cellulitis complicated by subperiosteal abscess due to Streptococcus pyogenes infection

Resumen: Introducción: La celulitis orbitaria es una enfermedad infecciosa muy frecuente en la edad pediátrica que puede provocar el desarrollo de severas complicaciones. Los principales microorganismos involucrados son Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae y Moraxella catarrhalis, que juntos corresponden al 95% de los casos. También se pueden presentar Streptococcus beta hemolíticos y microorganismos anaerobios, que corresponden a menos del 5% de los casos. Se presenta un caso poco frecuente de celulitis orbitaria complicada por absceso subperióstico ocasionado por Streptococcus pyogenes (estreptococo beta hemolítico del grupo A). Caso clínico: Paciente masculino de 9 años de edad con antecedente de trastorno por déficit de atención e hiperactividad desde los 5 años de edad. Inició su padecimiento actual por presentar eritema en canto externo del ojo derecho; posteriormente, aumento de volumen periorbicular con limitación de apertura palpebral, progresión a proptosis, dolor a los movimientos oculares y secreción conjuntival purulenta. Los estudios de imagen subperióstico reportaron absceso y preseptal derecho con celulitis extraocular. Se inició manejo empírico con antibióticos, drenaje quirúrgico y cultivo del material purulento. De este, se aisló Streptococcus pyogenes. Conclusiones: Debido a la implementación de los esquemas de vacunación desde la década de los 90 contra H. influenza y S. pneumoniae, los casos por estos patógenos han disminuido, provocando que nuevas bacterias tomen su lugar como causantes de la infección. La importancia de considerar a S. pyogenes como etiología de celulitis orbitaria radica en la rápida progresión para la formación de abscesos, así como los pocos casos descritos en la literatura.

Abstract: Background: Orbital cellulitis is an infectious disease that is very common in pediatric patients, in which severe complications may develop. Etiological agents related to this disease are Haemophilus influenzae B, Staphylococcus aureus, Streptococcus pneumoniae and Moraxella catarrhalis, which correspond to 95% of cases. Moreover, Streptococcus beta hemolytic and anaerobic microorganisms may also be present corresponding to < 5% of the cases. We present an uncommon case of cellulitis complicated by sub-periosteal abscess caused by Streptococcus pyogenes (Group A beta hemolytic streptococcus). Case report: A 9-year-old male patient with a history of deficit disorder and hyperactivity since 5 years of age. His current condition started with erythema in the external edge of the right eye, increase in peri-orbicular volume with limitation of eyelid opening, progression to proptosis, pain with eye movements and conjunctival purulent discharge. Image studies reported subperiosteal abscess and preseptal right with extraocular cellulitis. The patient started with empirical antibiotic treatment, surgical drainage and culture of purulent material from which Streptococcus pyogenes was isolated. Conclusions: Due to the implementation of vaccination schemes against H. influenza and S. pneumoniae since the 90s, the cases by these pathogens have decreased, causing new bacteria to take place as the cause of the infection. The importance of considering S. pyogenes as an etiology of orbital cellulitis is the rapid progression to abscess formation, and the few cases described in the literature.

Etmoiditis complicada con celulitis orbitaria en un lactante / Complicated ethmoiditis with orbital cellulitis in a nursling

Se define la etmoiditis como la inflamación e infección de la mucosa de las celdas etmoidales. Se diagnostica clínicamente con la presencia de edema en el ángulo medial del ojo, que se extiende a las estructuras adyacentes. Estudios imagenológicos son necesarios para verificar la presencia de complicaciones, entre las que se citan el absceso orbitario, subperióstico, epidural, subdural, cerebral, tromboflebitis del seno cavernoso, meningoencefalitis y la muerte del paciente. Streptococcus pneumoniae, Staphylococcus aureus y Haemophilus influenzae son microorganismos frecuentemente responsables de este cuadro. Las complicaciones orbitarias en las etmoiditis, necesitan el diagnóstico y tratamiento precoz para evitar secuelas irreversibles. Se presenta el caso de un lactante masculino, de 1 mes y 26 días de nacido, que ingresa con fiebre, rinorrea serosa y rechazo al alimento. Evolutivamente se constata marcada obstrucción nasal, edema periorbitario izquierdo, rubor, calor, protrusión del globo ocular e irritabilidad, y se diagnostica etmoiditis complicada con celulitis orbitaria. Se realiza tomografía axial computarizada que informa seno etmoidal izquierdo ocupado por contenido de densidad líquida con celularidad (15-25 UH), engrosamiento de partes blandas de la pared interna de la órbita que abomba, comprime y desplaza la musculatura orbitaria, y se extiende al párpado y al ala izquierda de la nariz desviando tabique blando; así como ligera proptosis, y disminución de la densidad ósea de la pared interna de la cavidad orbitaria. Se toma muestra para cultivo y se aísla Staphylococcus aureus meticillin resistente. Se comentan los elementos diagnósticos y su tratamiento, con el objetivo de llamar la atención de los pediatras para lograr el diagnóstico y tratamiento oportuno.

Ethmoiditis is the inflammation and infection of the ethmoidal cell mucus. It is clinically diagnosed after observing edema in the medial angle of the eye extending into the adjacent structures. Imaging studies are required to verify complications such as orbital, subperiostic, epidural, subdural, cerebral abscess; thrombophlebitis of the cavernous sinus, meningoencephalitis and finally death of the patient. Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae are frequently responsible for this health picture. The orbital complications seen in ethmoiditis require early diagnosis and treatment to avoid irreversible sequelae. This is the case of a male nursling aged one month and 26 days, who was admitted to the hospital with fever, rhinorrea serosa and rejection to feeding. As his condition progresses, it was observed that he presented with marked nasal obstruction, left periorbital edema, blushing, heat, eyeball protusion and irritability. He was finally diagnosed as complicated ethmoiditis with orbital cellulitis case. Computer axial tomography revealed left ethmoidal sinus filled with fluid content having cellularity rate of 15-25 UH, thickening of soft parts of the internal wall of the orbit that juts out, compresses and shifts the orbital musculature and extends into the eyebrow and to the left wing of the nose, thus deviating the soft septum in addition to slight proptosis and reduction of the bone density of the internal wall of the orbital cavity. A sample was taken for culturing, which resulted in isolation of methicillin-resistant Staphylococcus aureus. The diagnostic elements and the treatment of this disease were explained in order to call the pediatricians´attention to timely diagnose and treat these patients.

Celulitis orbitaria, celulitis frontal y empiema como complicaciones de sinusitis / Orbital cellulitis, frontal cellulitis and empyema as sinusitis complications

La celulitis orbitaria usualmente ocurre como complicación de infecciones de los senos para nasales, y la etiología es principalmente bacteriana. Para realizar un diagnóstico e implantar terapéutica temprana tiene gran importancia reconocer las manifestaciones clínicas de la sinusitis y las edades más afectadas, pues dada su ubicación anatómica, pueden complicarse también con infecciones del sistema nervioso central, que en la edad pediátrica tienen una connotación especial. Se presentan aquí dos pacientes de 10 y 14 años de edad respectivamente, que desarrollaron celulitis orbitaria en un caso, y celulitis frontal y empiema en el otro; así mismo, se muestran los medios diagnósticos utilizados para identificar signos tempranos de posibles complicaciones, con el objetivo que el pediatra pueda identificarlos, así como la terapéutica implantada para dar solución o evitar estas complicaciones

Orbital cellulite generally occurs as a complication of paranasal sinus infections and the etiology is mainly bacterial. It is very important to recognize the clinical manifestations of sinusitis and the most affected ages to make a correct diagnosis and to apply early treatment, since its anatomical location may bring complications with central nervous system infections which, at pediatric ages, can acquire special significance. Here are two patients aged 10 and 14 years, who developed orbital cellulitis in one case and frontal cellulitis and empyema in the other. Likewise, the diagnostic means used to identify the early signs of possible complications were presented, in order that a pediatrician can detect them, as well as the treatment to solve or to prevent these complications

Celulitis orbitaria neonatal por Staphylococcus aureus meticilinorresistente de la comunidad / Staphylococcus aureus methicillin-resistant community acquired neonatal orbital cellulitis

La celulitis orbitaria es una patología del niño mayor y raramente compromete al período neonatal. Staphylococcus aureus (SA) es el principal agente etiológico relacionado. El diagnóstico precoz y el tratamiento adecuado mejoran el pronóstico. Se presentan tres recién nacidos con celulitis orbitaria por SA meticilinorresistente de la comunidad (SAMR-CO).

Orbital cellulitis typically occurs in older children, but it can occasionally affect infants and neonates. Staphylococcus aureus is the main pathogen isolated. Outcome depends on an adequate initial approach. We report three neonates with orbital cellulitis caused by community- associated MRSA.

A Case of Odontogenic Orbital Cellulitis Causing Blindness by Severe Tension Orbit

We report a very rare case of odontogenic orbital cellulitis causing blindness by severe tension orbit. A 41-yr old male patient had visited the hospital due to severe periorbital swelling and nasal stuffiness while he was treated for a periodontal abscess. He was diagnosed with odontogenic sinusitis and orbital cellulitis, and treated with antibiotics. The symptoms were aggravated and emergency sinus drainage was performed. On the next day, a sudden decrease in vision occurred with findings of ischemic optic neuropathy and central retinal artery occlusion. Deformation of the eyeball posterior pole into a cone shape was found from the orbital CT. A high-dose steroid was administered immediately resulting in improvements of periorbital swelling, but the patient's vision had not recovered. Odontogenic orbital cellulitis is relatively rare, but can cause blindness via rapidly progressing tension orbit. Therefore even the simplest of dental problems requires careful attention.

Severe aseptic orbital cellulitis with subtenon carboplatin for intraocular retinoblastoma.

Retinoblastoma is a rare intraocular tumor of childhood. Chemoreduction followed by laser or cryotherapy is the treatment of choice. Subtenon carboplatin injection is also an accepted treatment modality for vitreous seeds, along with systemic chemotherapy. Transient periocular edema, optic neuropathy and fibrosis of orbital tissues are the known side effects of subteneon carboplatin injection. We report a case of severe aseptic orbital cellulitis with necrosis and prolapse of the conjunctiva 48 h after the injection, which resolved well on only conservative management.