Purtscher-like retinopathy following carotid angioplasty and stenting in the treatment of severe carotid stenosis.

We present a case of Purtscher-like retinopathy (PLR) following carotid angioplasty and stenting (CAS). A 56-year-old man with a history of severe stenosis of the left carotid artery and treated by CAS refers acute and painless visual loss on the left eye (OS) 48 h after the procedure. Funduscopic examination showed cotton wool spots and intraretinal hemorrhages confined to the peripapillary and posterior pole of the OS. The optical coherence tomography (OCT) showed retinal thickening and hyperintense lesions in the inner nuclear layer retina.

Fascitis necrosante periorbitaria secundaria a rascado / Periorbital necrotising fasciitis secondary to scratching

Mujer de 80 años sin antecedentes médicos que consulta por empeoramiento de picor y dolor palpebral derecho tras la picadura de un insecto. Presenta zonas de laceración por rascado en los párpados, que evolucionan a placas de necrosis fibrinoide durante las primeras 24 horas. Se cultivan las lesiones, demostrando Streptococcus pyogenes y Staphylococcus aureus. Se ingresa a la paciente con diagnóstico de fascitis necrosante periorbitaria para tratamiento intravenoso con ceftriaxona, linezolid y desbridamiento quirúrgico urgente. Permanece ingresada durante 17 días; se le realizan curas diarias consistentes en desbridamiento de restos necróticos, limpieza con clorhexidina y curas con pomadas de mupirocina, sulfadiazina y miconazol. Sufre síndrome de shock tóxico estreptocócico, del que se recupera durante la primera semana de ingreso. A las 2 semanas se le realiza reconstrucción plapebral con autoinjerto de piel de espesor total preauricular en el párpado superior y avance malar lateral en el párpado inferior, con adecuado resultado cosmético y funcional

An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24 hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained

Periorbital necrotising fasciitis secondary to scratching. / Fascitis necrosante periorbitaria secundaria a rascado.

An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained.

Tocilizumab as first treatment option in optic neuropathy secondary to Graves' orbitopathy.

Dysthyroid optic neuropathy (DON) is one of the complications that can affect Graves' orbitopathy (GO) patients. Its prevalence is estimated at less than 5%. It is usually treated with intravenous steroids, radiotherapy or orbital decompression. Tocilizumab has been proposed as a treatment option in cases of GO refractory to steroid treatment, with good clinical results. Our aim is to report the case of a patient with optic neuropathy secondary to GO treated with tocilizumab as primary treatment option.

Proptosis como manifestación inicial de linfoma de Burkitt con afectación orbitaria / Proptosis as initial manifestation of Burkitt's lymphoma with orbital involvement

CASO CLÍNICO: Una mujer de 35 años, sin antecedentes médicos conocidos, acudió a nuestro servicio de urgencias por proptosis dolorosa de rápida evolución. Los estudios de imagen mostraron una lesión que ocupaba senos frontales, etmoidales y órbita derecha. De acuerdo a la biopsia se diagnosticó de linfoma de Burkitt. La serología fue positiva para el virus de la inmunodeficiencia humana (VIH). CONCLUSIÓN: La afectación orbitaria es poco frecuente en el linfoma de Burkitt asociado al VIH. Es importante tenerlo en cuenta, como diagnóstico diferencial de las proptosis, especialmente en pacientes inmunodeprimidos, por la implicación pronóstica que supone tanto a nivel sistémico como ocular

CASE PRESENTATION: A 35-year-old woman without any known systemic disorder presented with a complaint of painful and rapidly increasing proptosis in her right eye. Based on the clinical, radiological, analytical and ophthalmological assessments, the diagnosis made was Burkitt's lymphoma in acquired immunodeficiency syndrome. CONCLUSION: Proptosis can be an unusual way of presenting with Burkitt's lymphoma associated with acquired immunodeficiency. This differential diagnosis is important because confirmation leads to a change in the vital prognosis of the patient

Proptosis as initial manifestation of Burkitt's lymphoma with orbital involvement. / Proptosis como manifestación inicial de linfoma de Burkitt con afectación orbitaria.

CASE PRESENTATION: A 35-year-old woman without any known systemic disorder presented with a complaint of painful and rapidly increasing proptosis in her right eye. Based on the clinical, radiological, analytical and ophthalmological assessments, the diagnosis made was Burkitt's lymphoma in acquired immunodeficiency syndrome. CONCLUSION: Proptosis can be an unusual way of presenting with Burkitt's lymphoma associated with acquired immunodeficiency. This differential diagnosis is important because confirmation leads to a change in the vital prognosis of the patient.

Melanocitoma de nervio óptico / Optic nerve melanocytoma

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Angiofibroma nasofaríngeo juvenil con extensión orbitaria / Juvenile nasopharyngeal angiofibroma with orbital extension

CASO CLÍNICO: Varón de 21 años con historia de exoftalmos izquierdo y diplopía de 2 semanas de evolución. La resonancia magnética mostró una lesión muy vascularizada etmoido-orbitaria con invasión de base del cráneo anterior y extensión orbitaria. La biopsia etmoidal confirmó un tejido fibrovascular compatible con angiofibroma. DISCUSIÓN: El angiofibroma nasofaríngeo juvenil (ANJ) es un tumor benigno con características locales de malignidad debido a su capacidad de invadir áreas adyacentes. En nuestro caso, el comienzo se presenta con manifestaciones de extensión orbitaria. Consideramos necesario un conocimiento amplio y un abordaje multidisciplinario con el fin de mejorar el pronóstico

CLINICAL CASE: The case is presented of a 21 year-old male with a history of left proptosis and diplopia of two weeks of onset. The MRI showed an ethmoid-orbital vascular lesion with anterior skull base invasion and orbital extension. Biopsy of the ethmoid confirmed fibrovascular tissue, which supported the diagnosis of angiofibroma. DISCUSSION: It is a benign neoplasm with local characteristics of malignancy due to its ability to invade adjacent areas. In this case, the debut presented with manifestations of orbital extension. A broad and multidisciplinary approach is needed in order to improve prognosis

[Juvenile nasopharyngeal angiofibroma with orbital extension]. / Angiofibroma nasofaríngeo juvenil con extensión orbitaria.

CLINICAL CASE: The case is presented of a 21 year-old male with a history of left proptosis and diplopia of two weeks of onset. The MRI showed an ethmoid-orbital vascular lesion with anterior skull base invasion and orbital extension. Biopsy of the ethmoid confirmed fibrovascular tissue, which supported the diagnosis of angiofibroma. DISCUSSION: It is a benign neoplasm with local characteristics of malignancy due to its ability to invade adjacent areas. In this case, the debut presented with manifestations of orbital extension. A broad and multidisciplinary approach is needed in order to improve prognosis.

Metotrexato como tratamiento en el penfigoide ocular cicatricial moderado / Methotrexate as a treatment in ocular cicatricial moderate pemphigoid

CASO CLÍNICO: Una mujer de 73 años se presenta con historia de molestias inespecíficas y fotofobia en ambos ojos (AO) de un año de evolución. A la exploración se observa un simbléfaron bilateral y acortamiento de fondos de saco. El análisis inmunohistoquímico (IHQ) confirma la presencia de un depósito lineal de Ig G, Ig M y C3 a lo largo de la membrana basal conjuntival. Ante el diagnóstico de penfigoide ocular cicatricial (POC) se pauta tratamiento sistémico mediante metotrexato (MTX) subcutáneo. DISCUSIÓN: Consideramos dicho tratamiento una alternativa inmunosupresora inicial muy eficaz en pacientes con inflamación conjuntival moderada y en casos de rápida progresión

CLINICAL CASE: A 73 year-old woman presented with a history of non-specific symptoms and photophobia in both eyes of 1 year progression. The examination revealed a bilateral symblepharon and fornix shortening. Immunohistochemical analysis confirmed the presence of linear deposits of IgG, IgM and C3 along the conjunctival basement membrane. With the diagnosis of Ocular Cicatricial Pemphigoid, systemic treatment with subcutaneous methotrexate was prescribed. DISCUSSION: We consider such treatment a very effective initial immunosuppressive alternative in patients with moderate conjunctival inflammation and in cases of rapid progression

Afectación orbitaria por linfoma no Hodgkin de células T NK / Orbital involvement by non-Hodgkin lymphoma NK T cells

CASO CLÍNICO: Un varón de 37 años se presenta por una historia de obstrucción nasal con rinorrea derecha, cefalea, hipoacusia y exoftalmos derecho de 4 meses de evolución. La RM revela la ocupación de senos etmoidales y maxilares por tejido inflamatorio con extensión hacia la región orbitaria. La biopsia confirma un linfoma no Hodgkin de células T natural killer (NK). DISCUSIÓN: El linfoma no Hodgkin T NK es un tumor infrecuente en el área orbitaria que precisa de una precoz detección así como de una atención multidisciplinaria para asegurar un seguimiento y tratamiento adecuados

CLINICAL CASE: The case is presented of 37 year-old male with a history of nasal obstruction with right rhinorrhea, headache, hearing loss and right exophthalmos of 4 months progression. The MRI revealed that the ethmoidal and maxillary sinuses contained inflammatory tissue extending into the orbital region. The biopsy confirmed a non-Hodgkin lymphoma of natural killer (NK) T cells. DISCUSSION: Non-Hodgkin's T NK lymphoma is a rare tumor in the orbital area that requires an early detection and multi-disciplinary care to ensure appropriate monitoring and treatment

Absceso orbitario tras anestesia peribulbar en mucocele frontoetmoidal / Orbital abscess after peribulbar anesthesia in a frontoethmoidal mucocele

CASO CLÍNICO: La anestesia peribulbar es una técnica habitual durante la cirugía de cataratas. Es una técnica segura pero no exenta de complicaciones. Se presenta el caso de un varón que desarrolló un absceso orbitario tras una anestesia peribulbar que produjo la perforación de un mucocele frontoetmoidal no conocido. Discusión: El absceso orbitario secundario a la perforación iatrogénica de un mucocele tras una anestesia peribulbar es una complicación hasta ahora no descrita. El diagnóstico precoz del proceso orbitario, el tratamiento médico intensivo y la monitorización de los signos de deterioro son vitales para la prevención de complicaciones serias

CLINIC CASE: Peribulbar anesthesia is used in daily practice during cataract surgery. It is a safe technique, but not without complications. We present the case of a man who had an orbital abscess secondary to peribulbar anesthesia that led to the perforation of an unknown frontoethmoidal mucocele. DISCUSSION: Orbital abscess secondary to an iatrogenic mucocele perforation after anesthesia is a periorbital complication not described. The detection of the orbital process, intensive medical treatment and monitoring for signs of deterioration are vital in preventing serious complications

Methotrexate as a treatment in ocular cicatricial moderate pemphigoid.

CLINICAL CASE: A 73 year-old woman presented with a history of non-specific symptoms and photophobia in both eyes of 1 year progression. The examination revealed a bilateral symblepharon and fornix shortening. Immunohistochemical analysis confirmed the presence of linear deposits of IgG, IgM and C3 along the conjunctival basement membrane. With the diagnosis of Ocular Cicatricial Pemphigoid, systemic treatment with subcutaneous methotrexate was prescribed. DISCUSSION: We consider such treatment a very effective initial immunosuppressive alternative in patients with moderate conjunctival inflammation and in cases of rapid progression.

[Orbital abscess after peribulbar anesthesia in a frontoethmoidal mucocele]. / Absceso orbitario tras anestesia peribulbar en mucocele frontoetmoidal.

CLINIC CASE: Peribulbar anesthesia is used in daily practice during cataract surgery. It is a safe technique, but not without complications. We present the case of a man who had an orbital abscess secondary to peribulbar anesthesia that led to the perforation of an unknown frontoethmoidal mucocele. DISCUSSION: Orbital abscess secondary to an iatrogenic mucocele perforation after anesthesia is a periorbital complication not described. The detection of the orbital process, intensive medical treatment and monitoring for signs of deterioration are vital in preventing serious complications.

Orbital involvement by non-Hodgkin lymphoma NK T cells.

CLINICAL CASE: The case is presented of 37 year-old male with a history of nasal obstruction with right rhinorrhea, headache, hearing loss and right exophthalmos of 4 months progression. The MRI revealed that the ethmoidal and maxillary sinuses contained inflammatory tissue extending into the orbital region. The biopsy confirmed a non-Hodgkin lymphoma of natural killer (NK) T cells. DISCUSSION: Non-Hodgkin's T NK lymphoma is a rare tumor in the orbital area that requires an early detection and multi-disciplinary care to ensure appropriate monitoring and treatment.