Extensively drug-resistant Pseudomonas aeruginosa panophthalmitis from contaminated artificial tears.

Pseudomonas aeruginosa is one of the common gram-negative organisms that cause severe invasive infections in different organ systems. P. aeruginosa has unique intrinsic mechanisms to develop antimicrobial resistance quickly, making it extremely difficult to treat. We report a case of extensively drug-resistant (XDR) P. aeruginosa panophthalmitis due to contaminated artificial tears. This report investigates the role of systemic and intravitreal antimicrobials, summarizes the resistance mechanisms of P. aeruginosa, and provides an overview on cefiderocol, a novel antimicrobial that targets multidrug-resistant (MDR) and XDR Gram-negative pathogens.

Parvimonas micra Necrotizing Panophthalmitis Involving the Sclera, Cornea, Uvea, Retina, and Orbit.

We present an unusual case of a patient who acquired a pansinusitis and orbital cellulitis with necrotizing features, subsequently developing scleritis, keratitis, and anterior uveitis. To date, there are no reported cases of the simultaneous involvement of these ocular structures from a pansinusitis. Our patient was urgently taken to the operating room for drainage of the abscesses within his sinuses and the orbit. Intraoperative cultures were positive for Parvimonas micra, an odontogenic anaerobic bacteria. He was additionally found to have a central retinal artery occlusion. He was treated with systemic and topical antibiotics as well as topical dilute hypochlorous acid. The mechanisms of virulence of P. micra, including its synergistic relationship with other bacteria, ability to bind plasminogen, and its expression of proteases, contributed to this diffuse infection.

Orbital and Eyelid Inflammation With "Muciphages" and Extravasated Mucin From an Ethmoido-orbital Mucocele.

A 22-year-old woman presented with an acute compressive optic neuropathy due to a ruptured ethmoido-orbital mucocele. She underwent urgent orbital decompression and drainage of the mucocele via an endoscopic approach. Postoperatively, her course was complicated by an orbital compartment syndrome supervened, exhibiting severe eyelid edema caused by infiltration with mucin and mucin-containing macrophages ("muciphages"). Biopsy of the eyelid showed infiltration with "muciphages," macrophages laden with extravasated mucinous material. This is the first report that documents the clinical and histopathologic course of orbital inflammation following mucocele extravasation into the orbit and eyelids.

Esophageal Squamous Cell Carcinoma Metastatic to the Orbit.

A 74-year-old man presenting with proptosis and orbital inflammation was found on magnetic resonance imaging to have a unilateral intraconal mass. Biopsy revealed a high-grade malignant tumor that was interpreted as squamous cell carcinoma. Positron emission tomography-computed tomography imaging subsequently identified a primary lesion in the esophagus. Esophageal squamous cell carcinoma is a rare cause of orbital metastasis, with only 4 previously reported cases. The authors discuss an approach to orbital malignancies of obscure origin.