A rare ocular complication of septicemia: a case series report and literature review.

BACKGROUND: Septicemia that leads to ocular involvement mostly presents as endophthalmitis or panophthalmitis. Contrarily, septicemia without intraocular involvement, known as hematogenous orbital cellulitis (HOC), involves only the orbit and is an extremely rare complication of septicemia and a rare type of orbital cellulitis. CASE PRESENTATION: Four male patients with septicemia presented with orbital involvement without intraocular infection were described in this study. They were 22 (case 1), 15 (case 2), 79 (case 3), and 30 (case 4) years old, with a mean age of 29.75 years. All patients were immunocompromised except for case 2. Cases 1 and 3 had a history of steroid use, whereas case 4 was in a post-chemotherapy myelosuppression phase. Septicemia in case 1 was community-acquired, cases 3 and 4 were hospital-acquired, and case 2 was secondary to acne squeezing. Blood cultures from cases 1, 2, and 3 were positive for Candida albicans, methicillin-resistant Staphylococcus aureus, and Klebsiella pneumoniae, respectively. Case 4 had negative cultures; however, next-generation sequencing reported the presence of Enterococcus faecalis and Rhizopus oryzae. Case 1 had right eye involvement, and both eyes were involved in the other three cases. According to Chandler's classification, case 1 was type 2, case 2 was type 2 (OD) and type 4 (OS), and cases 3 and 4 were type 1 orbital infections. All patients had eyelids erythema, and cases 1 and 2 had mildly decreased visual acuity, proptosis, and painful and restricted ocular motility. Hospital stays ranged from 13 to 43 days (mean, 24 days). All patients received systemic antibiotic therapy based on drug sensitivity and next-generation sequencing results, in combination with multidisciplinary treatment, resulting in complete recovery of ocular and systemic signs and symptoms; no ocular surgical interventions were performed. Extraocular muscle palsy was the last symptom to resolve. CONCLUSION: HOC is predominantly seen in immunocompromised individuals with a high proportion of hospital-acquired infections and positive cultures for pathogens. Infection control using systemic antibiotics targeted at the causative organism guarantees a favorable prognosis.

Vision loss due to uncommon "red eye": A case report.

RATIONALE: Phacolytic glaucoma is a rare complication induced by hypermature cataracts and may occasionally be encountered in some rural areas. It tends to be misdiagnosed and induces a risk of permanent vision impairment. PATIENT CONCERNS: A 63-year-old Uighur woman complained of redness and decreased vision in her right eye and was treated for endophthalmitis at a primary hospital before being referred to our hospital. DIAGNOSIS: On admission, the patient had weak light perception in the right eye, an intraocular pressure of 65 mmHg, and slit-lamp examination revealed swelling of the eyelids and significant injection of conjunctiva. The entire cornea was cloudy and edematous, whereas the aqueous humor was milky turbid. Cytological examination of the aqueous liquid confirmed the presence of lens protein-laden macrophages. A Morgagnian cataract was observed after anterior chamber irrigation. So the final diagnosis was phacolytic glaucoma. INTERVENTIONS: The patient received anterior chamber irrigation and extracapsular cataract extraction with intraocular lens implantation successively. OUTCOMES: Final visual acuity was limited to 6/120 due to secondary optic nerve damage. LESSONS: Phacolytic glaucoma can mimic endophthalmitis and tend to be misdiagnosed, causing permanent vision impairment. Improving awareness of phacolytic glaucoma and enhancing public health education regarding cataracts are ways to prevent phacolytic glaucoma and phacolytic glaucoma-related vision loss.