Multi-resistant Enterobacter cloacae dacryocystitis and preseptal cellulitis: case and review of literature.

A 61-year-old man with no significant past medical history presented to a quaternary ophthalmic referral center with acute right-sided medial canthal pain, periorbital edema, and erythema despite oral antibiotic therapy. CT imaging confirmed the presence of right preseptal cellulitis and lacrimal sac aspiration identified Enterobacter cloacae. A diagnosis of acute right-sided dacryocystitis with preseptal cellulitis was made. He was successfully treated with broadening of antibiotic therapy to intravenous meropenem. Symptomatic resolution was noted on follow-up without evidence of disease recurrence. This unusual case of Enterobacter cloacae dacryocystitis and preseptal cellulitis highlights the increasing prevalence and challenges of treating these uncommon organisms.

Cosmetic Filler Blindness: Recovery After Repeated Hyaluronidase Injections.

BACKGROUND: The rise of cosmetic injectables has involved new clinical scenarios related to complications. The scenario of hyaluronic acid (HA) aesthetic interventional-induced visual loss has become more recognized. Although this complication is rare, there can be delayed recognition and treatment, with limited opportunity to evaluate potential treatments and establish best practice guidelines. OBJECTIVES: The authors report a case of documented visual recovery with extra-orbital and intra-orbital hyaluronidase. Central retinal artery occlusion is an ischemic event requiring urgent intervention. The authors hope to assist protocols being developed for HA aesthetic interventional-induced visual loss. METHODS: Following loss of vision, 675 international units (IU) of hyaluronidase was given immediately to the injection site and extra-orbital area. Within 4 hours, 3000 IU intra-orbital and 1500 IU extra-orbital hyaluronidase were given. RESULTS: Visual loss in a 38-year-old female, following ipsilateral nasal injection of 0.15 mL of HA filler Juvéderm Voluma via the nasal tip, was documented at no perception of light with afferent pupil defect, central retinal artery occlusion, and fundoscopy showing a cherry red spot. This was associated with cerebral irritation and magnetic resonance imaging ischemia. Hyaluronidase was injected as described above. The following day, visual acuity (VA) in the affected eye recovered to 6/18 with a relative superior visual field scotoma. The VA improved to 6/6 at 1 month. CONCLUSIONS: The authors believe immediate injection followed by high dose intra-orbital and extra-orbital injection of hyaluronidase had a positive effect in this case. Recovery of vision was remarkable, from no perception of light to 6/6, documented at a tertiary referral eye hospital.

Actinomyces cavernous sinus infection: a case and systematic literature review.

A 63-year-old man presented with a 2-month history of progressive right-sided exophthalmos, painful ophthalmoplegia and fevers. As more features developed, he was diagnosed with giant cell arteritis, then Tolosa-Hunt syndrome, and transiently responded to corticosteroids. A bland cerebrospinal fluid and highly metabolically active brain (18F)-fluoro-D-glucose-positron emission tomography suggested lymphoma. Biopsy of the mass showed sulphur granules with Gram-positive filamentous bacteria with Actinomyces-like colonies. Actinomyces cavernous sinus infections are rare and indolent. They often mimic non-infective causes including other inflammatory and infiltrative conditions, vascular and neoplastic causes, particularly lymphoma. Clinicians should consider infective cavernous sinus syndromes in people with a fluctuating painful ophthalmoplegia that responds poorly to corticosteroids. The term Tolosa-Hunt syndrome is problematic and should be retired or used only with reservation.

Symmetry of retinal parameters measured by spectral-domain OCT in normal young adults.

PURPOSE: To determine interocular differences in retinal parameters in a population of young adults using spectral-domain optical coherence tomography. METHODS: In the Sydney Adolescent Vascular Eye Study, young adults aged 16 to 19 years received a standardized eye examination encompassing retinal photography, spectral-domain optical coherence tomography (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA) and best-corrected visual acuity. Interocular differences in retinal nerve fiber layer (RNFL) and macular parameters together with sex and ethnic variations for these differences were determined. RESULTS: In the 1500 subjects tested, right eyes had thicker average RNFL than left eyes (0.3 µm, P=0.0074). There were no significant interocular differences in central macular or macular cube average thickness. After adjusting for interocular difference in axial length, right eyes had slightly smaller total macular volume than left eyes (-0.0082 mm, P=0.008). The 2.5% to 97.5% limits of asymmetry were 9.3 µm for average RNFL, 8 µm for average macular thickness, and 0.20 mm for total macular volume. In the outer inferior quadrant, there was a greater macular thickness asymmetry in females than males (-0.7 µm, P=0.037). In the inferior RNFL quadrant (-2.6 µm, P=0.0013) and in the outer inferior macular quadrant (1.6 µm, P=0.0018), white individuals had greater symmetry than East Asians. CONCLUSIONS: In this study, we report the degree of interocular symmetry of RNFL and macular parameters measured by Cirrus HD-OCT in healthy young adults.