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Objective:To compare the efficacy of endoscopic sinus surgery and conservative treatment for orbital apex syndrome caused by sinus lesions. Methods:The clinical data of 56 patients with orbital apex syndrome caused by sinus lesions who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to August 2023 were retrospectively analyzed and divided into a surgical group of 21 cases and a conservative group of 35 cases. The clinical features and prognosis of the two groups were compared. Results:Among the sinus lesions in the surgical group, 61.9% were fungal sinusitis, 28.6% were bacterial sinusitis, and 9.5% were sphenoid sinus tumors. In the conservative group, non-fungal sinusitis accounted for 65.7% and fungal sinusitis accounted for 34.3%. In addition to sinus lesions, patients had underlying diseases. In the surgical group, 71.4% had hypertension and 80.9% had diabetes; in the conservative group, 28.6% had hypertension and 42.9% had diabetes. After a follow-up of 1 month to 5 years, the symptom improvement rate in the surgical group was 85.7%, with 1 case of recurrence. No recurrence was found after reoperation, while the symptom improvement rate in the conservative group was 22.9%, and 6 cases recurred after symptom improvement, and were transferred to rhinology department. No recurrence was seen after surgery. Conclusion:Most of the sinus lesions in this study were fungal sinusitis. In addition, patients with underlying diseases such as diabetes, hypertension, nephrotic syndrome, etc. have reduced nasal immunity, which significantly increases the risk of disease. Since early nasal symptoms are not obvious, multidisciplinary cooperation in diagnosis and treatment is very necessary. Once imaging examination suggests orbital apex syndrome caused by sinus lesions, endoscopic sinus opening should be performed as soon as possible.
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Endoscopía , Humanos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto , Sinusitis/complicaciones , Enfermedades Orbitales/etiología , Síndrome , Tratamiento Conservador/métodos , Enfermedades de los Senos Paranasales/complicaciones , Enfermedades de los Senos Paranasales/cirugía , PronósticoAsunto(s)
Absceso , Enfermedades Orbitales , Schizophyllum , Humanos , Absceso/microbiología , Absceso/tratamiento farmacológico , Absceso/diagnóstico por imagen , Enfermedades Orbitales/microbiología , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/tratamiento farmacológico , Schizophyllum/aislamiento & purificación , Masculino , Micosis/diagnóstico , Micosis/tratamiento farmacológico , Micosis/microbiología , Antifúngicos/uso terapéutico , Tomografía Computarizada por Rayos X , FemeninoRESUMEN
PURPOSE: To assess the utility of a marginal full thickness blepharotomy (MFTB) for the treatment of orbital compartment syndrome. METHODS: An experimental study design employing a cadaver model for orbital compartment syndrome was used to assess the efficacy of an MFTB. Elevated orbital compartment pressures were created in 12 orbits of 6 fresh cadaver heads. Intraocular pressure, as an analog of orbital pressure, was measured before and after inferior and superior MFTBs were performed. Statistical analysis was performed on the collected data to assess the efficacy of the procedure. RESULTS: Both procedures were found to significantly lower the orbital compartment pressure. MFTB of the inferior lateral eyelid decreased orbital compartment pressure by an average of 62.2 mm Hg (95% CI, 56.9-67.5). MFTB of the superior lateral eyelid following MFTB of the inferior lateral eyelid decreased the orbital compartment pressure by an additional average of 10.3 mm Hg (total average reduction of 72.5 mm Hg; 95% CI, 68.1-76.9). CONCLUSIONS: Orbital compartment syndrome is a time-sensitive vision-threatening emergency that requires prompt diagnosis and intervention to prevent irreversible vision loss. The authors describe the MTFB, a simple one-step procedure that when performed correctly results in a significant decrease in orbital compartment pressure, making it a viable option when canthotomy and cantholysis fails or is unable to be performed.
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Cadáver , Síndromes Compartimentales , Párpados , Presión Intraocular , Enfermedades Orbitales , Humanos , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/fisiopatología , Síndromes Compartimentales/etiología , Párpados/cirugía , Presión Intraocular/fisiología , Enfermedades Orbitales/cirugía , Enfermedades Orbitales/diagnóstico , Órbita/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodosRESUMEN
Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, invasive, and fatal fungal disease that is often easily misdiagnosed in the early stages due to the lack of specific clinical manifestations and adequate auxiliary examinations. Early diagnosis and timely therapy are essential for successful treatment. In this report, we presented a 46-year-old man with diabetes who experienced gradual vision loss, right ptosis, swelling, and headaches that progressively worsened to death within 4 days after admission. It was finally confirmed as a fungal Rhizopus arrhizus infection by metagenomics next-generation sequencing (mNGS). Our report has proved that mNGS testing should be strongly recommended in highly suspected patients.
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Secuenciación de Nucleótidos de Alto Rendimiento , Metagenómica , Mucormicosis , Rhizopus , Humanos , Mucormicosis/diagnóstico , Mucormicosis/microbiología , Masculino , Rhizopus/genética , Rhizopus/aislamiento & purificación , Persona de Mediana Edad , Metagenómica/métodos , Resultado Fatal , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/microbiología , Antifúngicos/uso terapéuticoRESUMEN
PURPOSE: Within the large umbrella of histiocytosis are a few similar yet heterogenous entities involving the orbit and periocular tissues with or without systemic infiltration, termed adult onset xanthogranuloma or orbital xanthogranuloma. Due to rarity of these conditions, different classifications in use, diverse clinical presentations and still unknown etiology, the aim of this paper was to provide an up-to-date literature review of the actual understanding of histiocytosis and its subgroups involving the orbit and periocular area, diagnostic strategies and therapeutic modalities. METHODS: We present a review of literature and small case series comprising four patients diagnosed and treated in the period from 2001 until 2023 in our hospital. Clinical files of 4 patients with adult-onset xanthogranulomatous disease of the orbit and ocular adnexa (AOXGD) were reviewed retrospectively. Clinical, laboratory, radiological, histopathological, and immunohistochemical findings were reexamined. RESULTS: Reviewing medical records of our patients with AOXGD, we found significant overlap between histiocytosis and different immune disorders. A broad workup should be considered in these patients as they can harbour severe immune disfunctions and hematologic disorders. Preferred treatment modality depends on a histopathologic type of AOXGD, clinical presentation and systemic involvement and should be conducted multidisciplinary. CONCLUSION: The diagnosis is often delayed because of its rarity and diverse clinical findings. Development of molecular genetic tests, detection of BRAF V600E mutation and different types of kinase mutations, mutations in transcriptional regulatory genes as well as tyrosine kinase receptors have shed a new light on the etiopathogenesis and potential targeted treatment of histiocytosis.
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Enfermedades Orbitales , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Granuloma/diagnóstico , Histiocitosis/diagnóstico , Enfermedades Orbitales/diagnóstico , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Xantomatosis/diagnóstico , AncianoRESUMEN
This case report discusses a diagnosis of rhino-orbital-cerebral mucormycosis in a man aged 61 years who presented with vision loss, ophthalmoplegia, and ptosis.
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Infecciones Fúngicas del Ojo , Mucormicosis , Enfermedades Orbitales , Humanos , Mucormicosis/diagnóstico , Mucormicosis/microbiología , Mucormicosis/tratamiento farmacológico , Enfermedades Orbitales/microbiología , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/tratamiento farmacológico , Infecciones Fúngicas del Ojo/microbiología , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Masculino , Antifúngicos/uso terapéutico , Imagen por Resonancia Magnética , Enfermedades de los Senos Paranasales/microbiología , Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades de los Senos Paranasales/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Enfermedades Nasales/microbiología , Enfermedades Nasales/diagnóstico , Enfermedades Nasales/tratamiento farmacológico , Femenino , Persona de Mediana Edad , Anfotericina B/uso terapéuticoRESUMEN
PURPOSE: Topical prostaglandin analogues are commonly used to treat patients with glaucoma, but may cause periocular and periorbital complications known as prostaglandin-associated periorbitopathy syndrome (PAPS). METHODS: A literature review was conducted on PAPS. Given the lack of consensus on grading PAPS, glaucoma specialists from Asia convened to evaluate current PAPS grading systems and propose additional considerations in grading PAPS. RESULTS: Existing grading systems are limited by the lack of specificity in defining grades and consideration for patients' subjective perception of symptoms. Patient-reported symptoms (e.g., via a self-assessment tool) and additional clinical assessments (e.g., exophthalmometry, lid laxity, differences between tonometry results, baseline measurements, and external ocular photographs) would be beneficial for grading PAPS systematically. CONCLUSIONS: Effective management of PAPS could be facilitated by a common clinical grading system to consistently and accurately diagnose and characterise symptoms. Further research is required to validate specific recommendations and approaches to stage and monitor PAPS.
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Glaucoma , Humanos , Glaucoma/tratamiento farmacológico , Presión Intraocular/fisiología , Presión Intraocular/efectos de los fármacos , Enfermedades Orbitales/inducido químicamente , Enfermedades Orbitales/diagnóstico , Asia/epidemiología , Síndrome , Prostaglandinas Sintéticas/efectos adversos , Antihipertensivos/efectos adversosRESUMEN
Adult orbital xanthogranulomatous disease (AOXGD) is a spectrum of histiocytoses with four subtypes. Mitogen-activated protein kinase (MAPK) pathway mutations have been detected in various histiocytic neoplasms, little is known about this in AOXGD. Targeted regions of cancer- and histiocytosis-related genes were analyzed and immunohistochemical staining of phosphorylated ERK (pERK), cyclin D1 and PU.1 was performed in 28 AOXGD and 10 control xanthelasma biopsies to assess MAPK pathway activation. Mutations were detected in 7/28 (25%) patients. Positive staining for pERK and/or cyclin D1 was found across all subtypes in 17/27 (63%) patients of whom 12/17 (71%) did not harbour a mutation. Xanthelasma tissue stained negative for pERK and cyclin D1. Relapse occurred in 5/7 (71%) patients with a MAPK pathway mutation compared to 8/21 (38%) patients in whom no mutation could be detected. Molecular analysis and evaluation for systemic disease is warranted to identify patients at risk of recurrent xanthomatous disease.
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Sistema de Señalización de MAP Quinasas , Mutación , Xantomatosis , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Sistema de Señalización de MAP Quinasas/genética , Anciano , Xantomatosis/genética , Enfermedades Orbitales/genética , Ciclina D1/genética , Ciclina D1/metabolismo , Adulto Joven , Granuloma/genéticaRESUMEN
INTRODUCTION: Subperiosteal orbital abscesses (SPOA) are the most common suppurative complications of acute bacterial sinusitis. Medial SPOAs arise from infection of the ipsilateral ethmoid sinus and favor initial conservative management reserving surgical drainage for patients who do not demonstrate clinical improvement. No standard algorithm defining medical versus surgical treatment of medial SPOAs exist in the pediatric population. OBJECTIVES: To identify a size cutoff for medial SPOAs to predict the likelihood for surgical drainage. METHODS: This is a retrospective review of patients with medial SPOAs at a tertiary care center from 2003 to 2017. Diagnosis of SPOA was based on radiographic findings. Variables included are patient demographics, antibiotic therapy, surgical intervention, and length of stay. RESULTS: 82 patients with a medial SPOA were included with an average age at presentation of 6.27 (range 0-15) years were included in this study. 62 patients were male (75.6 %), and 20 were female (24.4 %). The average abscess length was 16.1 mm, range 4.5-30.7 mm. The average abscess width was 4.17 mm, range 1.5-14.6 mm. The odds ratio for surgical treatment with every 1 mm increase in abscess width was 1.89 (95CI:1.33-2.69, p < 0.001). Abscesses over 3.6 mm width were 6.65 times more likely to undergo surgical drainage than those less than 3.6 mm (OR:6.65, 95CI:2.52-17.54, p < 0.001). The average(SD) length of stay was 5.4(3.0) days for patients who underwent surgery and 4.0(0.9) days for patients treated with conservative measures, p < 0.001. CONCLUSION: Medial SPOAs greater than 3.6 mm were more likely to undergo surgical drainage; however there was no difference in the likelihood of drainage between anteriorly and posteriorly based medial abscesses. These findings help further characterize the landscape of pediatric subperiosteal abscesses that are managed with surgical drainage.
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Absceso , Drenaje , Enfermedades Orbitales , Humanos , Femenino , Masculino , Niño , Estudios Retrospectivos , Absceso/terapia , Absceso/cirugía , Adolescente , Preescolar , Drenaje/métodos , Lactante , Enfermedades Orbitales/terapia , Enfermedades Orbitales/cirugía , Sinusitis/terapia , Sinusitis/cirugía , Sinusitis/microbiología , Antibacterianos/uso terapéutico , Recién Nacido , Resultado del Tratamiento , Tomografía Computarizada por Rayos X , Tiempo de Internación/estadística & datos numéricosRESUMEN
Facial fractures and their historical link to potential blindness have been well-documented, often attributed to optic canal injuries or retinal vascular occlusion. This dire consequence can result from both direct and indirect ocular trauma, including retrobulbar hemorrhage. Traumatic orbital compression can manifest in various forms, such as hematomas, fractured bone fragments, and emphysema, all posing a significant threat to vision, necessitating immediate intervention. In this study, 9 clinical cases of traumatic orbital compression are presented, each characterized by distinct etiologies. The study delves into traumatic orbital compressive syndromes, underscoring the critical imperative of early recognition and treatment to prevent vision loss. Orbital compression, whether from edema, hematoma, or emphysema, collectively culminates in elevated intraorbital pressure and the potential for optic nerve ischemia. Through the presentation of these 9 clinical cases, the article emphasizes the pressing need for timely intervention in addressing orbital compressive syndromes to avert vision loss. Various surgical techniques are elucidated, highlighting the pivotal role of expeditious medical intervention. This article offers invaluable insights into the diagnosis, management, and outcomes of traumatic orbital compressive syndromes.
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Enfermedades Orbitales , Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Enfermedades Orbitales/etiología , Enfermedades Orbitales/terapia , Enfermedades Orbitales/cirugía , Hemorragia Retrobulbar/etiología , Fracturas Orbitales/cirugía , Fracturas Orbitales/complicaciones , Hematoma/etiología , Resultado del Tratamiento , Enfisema/etiología , Enfisema/terapia , Edema/etiología , Síndrome , Anciano , Tomografía Computarizada por Rayos X , Ceguera/etiología , Descompresión Quirúrgica/métodosRESUMEN
PURPOSE: Histiocytosis is one of the most challenging diseases in medical practice. Because of the broad spectrum of clinical manifestations, systemic involvements, unknown etiology, and complex management, different types of histiocytosis are still a big question mark for us. Orbital histiocytosis is characterized by the abnormal proliferation of histiocytes in orbital tissues. It could affect the orbit, eyelid, conjunctiva, and uveal tract. Orbital histiocytosis can cause limited eye movement, proptosis, decreased visual acuity, and epiphora. In this study, we review the novel findings regarding the pathophysiology, diagnosis, and treatment of different types of histiocytosis, focusing on their orbital manifestations. METHOD: This review was performed based on a search of the PubMed, Scopus, and Embase databases or relevant published papers regarding orbital histiocytosis on October 9th, 2023. No time restriction was proposed, and articles were excluded if they were not referenced in English. RESULTS: 391 articles were screened, most of them being case reports. The pathophysiology of histiocytosis is still unclear. However, different mutations are found to be prevalent in most of the patients. The diagnostic path can be different based on various factors such as age, lesion site, type of histiocytosis, and the stage of the disease. Some modalities, such as corticosteroids and surgery, are used widely for treatment. On the other hand, based on some specific etiological factors for each type, alternative treatments have been proposed. CONCLUSION: Significant progress has been made in the detection of somatic molecular changes. Many case studies describe various disease patterns influencing the biological perspectives on different types of histiocytosis. It is necessary to continue investigating and clustering data from a broad range of patients with histiocytosis in children and adults to define the best ways to diagnose and treat these patients.
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Histiocitosis , Enfermedades Orbitales , Humanos , Histiocitosis/diagnóstico , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/etiología , Histiocitos/patologíaRESUMEN
BACKGROUND: Echinococcosis, commonly known as hydatid disease, is a zoonotic infection resulting from the tapeworm Echinococcus granulosus. The occurrence of hydatid cysts in the orbital region is uncommon, representing less than 1% of all reported hydatid cases. This report details a unique case of an intramuscular hydatid cyst in the orbital region that led to compressive optic neuropathy. CASE PRESENTATION: A 22-year-old male from Kabul, Afghanistan presented with a five-month history of progressive proptosis in his left eye, associated with a gradual decrease in vision over the past three weeks. The left eye exhibited upward globe dystopia, ocular motility limitation, mild conjunctival injection, and chemosis. Diagnosis was achieved through imaging and histopathological examination. Treatment involves surgical removal of the cyst and prolonged albendazole therapy. The postoperative course showed significant improvement in the patient's condition and restoration of his vision. CONCLUSIONS: Despite its rarity, this case underscores the importance of awareness and knowledge of hydatid disease among physicians, especially those working in endemic areas. It emphasizes the importance of including hydatid disease in the differential diagnosis of orbital masses, particularly in endemic regions.
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Equinococosis , Infecciones Parasitarias del Ojo , Enfermedades del Nervio Óptico , Enfermedades Orbitales , Humanos , Masculino , Equinococosis/diagnóstico , Equinococosis/complicaciones , Adulto Joven , Enfermedades del Nervio Óptico/diagnóstico , Enfermedades del Nervio Óptico/parasitología , Enfermedades del Nervio Óptico/cirugía , Infecciones Parasitarias del Ojo/diagnóstico , Infecciones Parasitarias del Ojo/parasitología , Infecciones Parasitarias del Ojo/cirugía , Enfermedades Orbitales/parasitología , Enfermedades Orbitales/diagnóstico , Imagen por Resonancia Magnética , Albendazol/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
Orbital disorders in children consist of varied pathologies affecting the orbits, orbital contents, visual pathway, and innervation of the extraocular or intraocular muscles. The underlying etiology of these disorders may be traumatic or nontraumatic. Presumed location of the lesion along with the additional findings, such as eye pain, swelling, exophthalmos/enophthalmos, erythema, conjunctival vascular dilatation, intraocular pressure, etc, help in determining if imaging is needed, modality of choice, and extent of coverage (orbits and/or head). Occasionally, clinical signs and symptoms may be nonspecific, and, in these cases, diagnostic imaging studies play a key role in depicting the nature and extent of the injury or disease. In this document, various clinical scenarios are discussed by which a child may present with an orbital or vision abnormality. Imaging studies that might be most appropriate (based on the best available evidence or expert consensus) in these clinical scenarios are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Enfermedades Orbitales , Humanos , Niño , Estados Unidos , Enfermedades Orbitales/diagnóstico por imagen , Medicina Basada en la Evidencia , Sociedades Médicas , Diagnóstico por Imagen/métodos , Ceguera/diagnóstico por imagenAsunto(s)
Infecciones por Pseudomonas , Pseudomonas aeruginosa , Sinusitis , Humanos , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa/aislamiento & purificación , Sinusitis/microbiología , Sinusitis/complicaciones , Masculino , Síndrome de Inmunodeficiencia con Hiper-IgM/complicaciones , Enfermedades Orbitales/etiología , Enfermedades Orbitales/microbiología , Niño , FemeninoRESUMEN
INTRODUCTION: We describe the first case of ALHE in the orbit with extension to the maxillary sinus and the importance of a multidisciplinary approach to achieve removal of the lesion. CASE STUDY: A 72-year-old man presented with epiphora of the left eye and several episodes of recurrent acute dacryocystitis. Magnetic resonance imaging revealed a solid homogeneous mass located in the inferomedial region of the left orbit. In addition, it was associated with destruction of the adjacent ethmoidal wall and upper wall of the left maxillary sinus. Incisional biopsy of the orbital mass was compatible with ALHE. RESULTS: It was decided to perform surgery using an orbital floor approach, left medial wall via subconjunctival and caruncular approach together with an endoscopic nasal approach (ESS), achieving complete removal of the orbital mass and cleaning of the maxillary sinus. After one year of treatment, no tumor recurrence was evident through endoscopy and imaging tests and the patient is asymptomatic. CONCLUSIONS: ALHE is a very rare benign vascular tumor that presents subcutaneous nodules in the head and neck region. We do not know of any case of ALHE in the paranasal sinuses described in the literature, either in isolation or together with orbital or cutaneous ALHE. In conclusion, ALHE disease should be considered as a diagnosis when faced with an orbital mass with extension to the paranasal sinuses, and a complete excision through a combined endonasal and orbital approach prevents recurrence in most cases.
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Hiperplasia Angiolinfoide con Eosinofilia , Imagen por Resonancia Magnética , Seno Maxilar , Humanos , Anciano , Masculino , Hiperplasia Angiolinfoide con Eosinofilia/cirugía , Hiperplasia Angiolinfoide con Eosinofilia/patología , Hiperplasia Angiolinfoide con Eosinofilia/diagnóstico , Hiperplasia Angiolinfoide con Eosinofilia/complicaciones , Seno Maxilar/patología , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/cirugía , Endoscopía/métodos , Enfermedades Orbitales/cirugía , Enfermedades Orbitales/patología , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/etiologíaRESUMEN
Giant cell reparative granuloma has a very low incidence and is thought to be a response to trauma. While there have been only a few reported cases of orbital giant cell reparative granuloma, we recently observed such a case and analyzed 16 previously reported cases of this type. It is important to note that further investigation is necessary to fully understand the relationship between giant cell reparative granuloma and trauma.