Nayana A Potdar

Orbital Cellulitis with Endogenous Panophthalmitis caused by Methicillin-Sensitive Staphylococcus aureus in pregnancy

Orbital cellulitis along with panophthalmitis is uncommon. The causes are usually trauma-related or endogenous. The prognosis in terms of globe salvage is very poor, with most cases usually requiring enucleation or evisceration of the affected eye. Immunosuppression in some form is usually present, which accounts for the aggressive course of the infection. In this communication, we report on a case in a 25-year-old female, who in the second trimester of pregnancy had developed orbital cellulitis and panophthalmitis caused by methicillin-sensitive Staphylococcus aureus (MSSA), with the primary source of infection being cellulitis on her forearm following intravenous therapy for severe anemia. Despite intensive intravenous and topical antibiotics, she required an evisceration of the eye. However, the pregnancy continued uneventfully with the delivery of a full-term, healthy infant. Bacteremia, although rare in pregnancy, can cause endogenous panophthalmitis and orbital cellulitis, especially in a background of immunosuppresssion.

Transcutaneous Endoscopic Orbital Surgery: A Less Morbid Alternative to Lateral Orbitotomy

Abstract Background: Retrobulbar lesions of the orbit situated lateral to the optic nerve are difficult to access. In this article, the authors would like to present a new perspective to approach these lesions where the goals of surgery are met with minimal complications. Methods: A retrospective analysis of patients’ charts was performed. Results: For approaching retrobulbar lesions an endoscopic technique was developed. Four patients (2 male and 2 female patients) presenting with retrobulbar lesions lateral to the optic nerve have been included in this study. Two patients underwent endoscopic drainage for orbital abscess and two patients were successfully biopsied endoscopically. No intra-operative complications were noted. Open procedures such as lateral orbitotomy were avoided in all the cases. Conclusion: Transcutaneous orbital endoscopy is a safe and a versatile technique to approach retrobulbar lesions lateral to the optic nerve. It can be used as an effective alternative to lateral orbitotomy for well selected cases. One can obtain adequate material for histopathological examination and also drain deep-seated orbital abscess using this technique. It would be possible with increasing experience to use this technique for extended applications.

Giant Perivascular Epithelioid Cell Tumor of the Orbit: A Clinicopathological Analysis and Review of the Literature

Aim: To describe and review the clinical, radiological, and histopathological characteristics of an orbital perivascular epithelioid cell tumor (PEComa). Methods: A systematic review of clinical records, radiological investigations, microscopic features, and immunohistochemical characteristics was done. Results: A 9-year-old female child presented with a year-long history of a large orbital mass associated with painless, progressive proptosis of the right eye. Radiologically, a well-defined orbital mass was seen with no intracranial extension. Excision was performed and histopathological examination showed uniform epithelioid cells in nests separated by thin fibrovascular septae. The tumor cells stained positively for Human Melanoma Black-45, but negatively for desmin, S-100, smooth muscle actin, MyoD1, microphthalmia-associated transcription factor, vimentin, CD10, CD31, and CD34 with a low proliferation index of 5–7%. Based on the tumor’s morphological and immunohistochemical characteristics, a diagnosis of giant orbital PEComa was made. No recurrence was seen at the last follow-up. Conclusions: PEComas are uncommon mesenchymal neoplasms that have typical histological features, with an immunohistochemical profile of negativity for epithelial markers and positivity for melanocytic markers. For benign PEComas, complete excision is advised. However, since PEComas elsewhere in the body have been known to be malignant, a close follow-up of such cases is recommended.

Nontraumatic subperiosteal orbital hemorrhage following upper gastrointestinal endoscopy

Subperiosteal hemorrhages are typically the result of blunt orbital or facial trauma. Nontraumatic subperiosteal hemorrhages are uncommon and are usually attributed to increase in central venous pressure and bleeding disorders. Here, we report the case of a 38-year-old female who underwent an upper gastrointestinal (GI) endoscopy and developed bilateral nontraumatic subperiosteal hemorrhages that resolved with conservative treatment. Here, we discuss the source of bleeding and the mechanisms for the occurrence of orbital subperiosteal bleeds. GI surgeons and ophthalmologists should be sensitive to the possibility that orbital hemorrhage that can occur following endoscopy, especially when retching or gagging occurs during the procedure.

Actinomycetes canaliculitis complicating congenital nasolacrimal duct obstruction in an infant

Actinomyces israelii is a Gram-positive anaerobic organism commonly associated with canaliculitis in adults. Pediatric canaliculitis is relatively rare, especially in infancy. We report the case of an 11-month-old boy who presented with co-existing canaliculitis and congenital nasolacrimal obstruction. The presenting signs included epiphora, discharge, conjunctival congestion, and matting of lashes. On examination, punctual pouting, regurgitation, and yellow canaliculiths were noted. A punctoplasty and canalicular curettage were performed along with nasolacrimal probing. Microbiological tests confirmed the organisms to be A. israelii. We discuss the clinical features and management of Actinomyces-associated canaliculitis and review the available literature on pediatric canaliculitis.

Salmonella Typhi Associated Endogenous Endophthalmitis: A Case Report and a Review of Literature

ABSTRACT Aim: To report a rare case of Salmonella typhi associated endogenous endophthalmitis in an immunocompetent male and to review the available literature. Methods: Retrospective chart review. Results: A 28-year-old immunocompetent male presented with a 3-day-old history of pain, redness and diminished vision in his left eye. Conjunctival chemosis, corneal haze, and hypopyon were noted and yellowish exudates filled the vitreous cavity. A detailed elicitation of history revealed that patient had been treated for enteric fever that presented with diarrhea and fever, two weeks prior to current presentation. Blood and vitreous cultures grew Gram negative bacilli, identified as S. typhi. Despite intensive intravitreal and systemic antibiotic therapy, an evisceration had to be performed. Conclusions: Endogenous endophthalmitis can be one of the rare sequelae of enteric fever and may present in the acute and relapsing phases and often times have a rapidly fulminant course with poor visual outcomes.

An unusual eyelid mass of cysticercosis: A twist in the tale

Cysticercosis is a parasitic infestation caused by the larval form of the tapeworm, Taenia solium (T. solium). The common sites for cysticerosis include the brain, eyes, and skeletal muscle. Ocular or adnexal involvement is commonly seen with the commonest ophthalmic site being subretinal space and the vitreous cavity. However, only a handful of cases of eyelid cysticercosis have been reported in the past. We report a rare and unusual case of isolated eyelid cysticercosis in a middle-aged woman masquerading as an asymptomatic slowly growing subcutaneous painless mass in the left eyelid which was presumed to be a benign skin mass, a cyst of appendageal origin such as an epidermoid cyst. This case highlights the ubiquitous nature of cysticercosis in tropical countries and the need for a high degree of suspicion while surgically treating subcutaneous masses. We would additionally emphasize the need to rule out neurocysticercosis in such cases.

Isolated conjunctival mass presenting as acute myeloid leukemia in an infant.

Ophthalmic manifestations of acute leukemia are commonly seen in the choroid and retina; however, conjunctival leukemic lesions are uncommon. We report a case of a 7-month-old female child presented with a fleshy conjunctival mass seen growing in the left eye since 1-month [Figure 1A]. The mass was deep pink in colour, painless and the conjunctiva appeared chemotic [Figure 1B]. There was no proptosis and ophthalmic examination was otherwise normal. The mass was soft-to-firm in consistency and showed prominent corkscrew vessels. A computed tomography scan showed an ill-defined, isodense mass [Figure 2] in the anterior orbit infiltrating the left medial rectus muscle (yellow arrow). An incisional biopsy was planned to ascertain the diagnosis. However, during the preoperative work-up, deranged blood counts prompted a peripheral blood smear to be performed, which showed the presence of blast cells in a background of hypochromic microcytic anaemia. A bone marrow aspirate confirmed the diagnosis of acute myeloid leukemia. The child was initiated on chemotherapy but succumbed to sepsis within 2 months of treatment.

Vincristine-Induced Neuropathy Presenting as Ptosis and Ophthalmoplegia in a 2-Year-Old Boy.

Vincristine is used in the treatment of leukemias, solid tumors, and lymphomas. A case of a 2-year-old boy undergoing treatment for leukemia who developed sudden onset bilateral ptosis and ophthalmoplegia along with generalized neuropathy due to vincristines neurotoxic effects is presented. He was successfully treated with pyridoxine and pyridostigmine. The possible mechanisms of action and the treatment for vincristine-induced neuropathy are discussed. Prompt treatment and close follow-up is needed, especially in children because prolonged ptosis and motility restriction may have a profound effect on a childs visual function.