Orbital Cellulitis in Children: Experience of the Pediatric Service at Mohammed v Military Hospital

Background: Orbital cellulitis is a diagnostic and therapeutic emergency, jeopardizing the vital and functional prognosis. This study aimed to analyze the epidemiological, therapeutic and evolutional aspects of orbital cellulitis cases treated at the pediatric service at Mohamed V military hospital. Patients and methods: retrospective study including all the children aged between 1 month and 15 years treated for orbital cellulitis at the pediatric service of the Mohamed V Hospital over a period of 3 years (1st January 2016-31st December 2019). Results: 24 cases of orbital cellulitis were gathered. Age varied between 1 month and 15 years with a median of age of 6. years. Feminine predominance (58%) was noted . The disease mainly involved the sinus (32%).Clinically, fever was present in 10 patients (41%),palpebral edema was universal, proptosis was noted in 5 cases(20.8%),chemosis and ptosis were noted in 4 cases(16.6%),bacteriological testing identified micro-organisms in 3 cases. An orbital CT scan was performed in all cases of our study, showing preseptal cellulitis in 14 cases (58.3%), orbital cellulitis in 3 cases(12.5%),and orbital abscess in 7 cases. The medical treatment consisted of ceftriaxone, metronidazole and aminoside or amoxicilline clavulanic acid, corticosteroid therapy prescribed in 5 cases. Surgical treatment was indicated in 3 patients. The outcome of All cases was favorable. Conclusion: The majority of our cases had a positive evolution highlighting the advantage of an early diagnosis, and adapted antibiotic and a multidisciplinary patient care making the need for surgery rarely necessary.

Complete manuscript title: Neurological complications from sinugenic orbital cellulitis

Introduction: This study was undertaken with an aim to identify any common factors or trends among patients of orbital cellulitis that developed neurological complications. Methods: A 24-month retrospective review of patients was undertaken to include those showing clinical deterioration and neurological complications on radiological imaging, after being treated for orbital cellulitis at Manchester Royal Eye Hospital. The study specifically looked at the site of orbital collection, sinus involvement, types of neurological complications and whether these were detected at initial presentation, surgical input and microbiology findings. Results: Nine patients (9/26) developed associated neurological complications during the study period. (February 2018 and January 2020) This included subdural empyema in six patients; leptomeningeal enhancement in two and septic emboli in one patient. All the patients had associated significant pan-sinusitis at initial presentation. Neurological complications were detected in three patients at the time of admission and after clinical deterioration and further investigations in the rest. Conclusion: A superior orbital abscess and Streptococcus mileri infection had higher risk of neurological complications. It is worth debating whether patients with chronic sinusitis who develop orbital cellulitis need earlier surgical input rather than a conservative treatment. Patients who fail to improve clinically need to be re-imaged to look for possible neurological complications.

Case Report: A Rare Orbital Abscess Caused by Dacryocystitis After Administration of Rebamipide Ophthalmic Suspension

Background: Rebamipide ophthalmic suspension was launched in Japan in 2012 and is used for the treatment of dry eye.Case Presentation: We report two cases of orbital abscess, which resulted from dacryocystitis that occurred after administration of rebamipide ophthalmic suspension. Computed tomography images showed an eyeball deformity in one case and exophthalmos in the other. In both cases, light microscopy, scanning electron microscopy and energy dispersive X-ray examinations revealed lacrimal sac concretions, which contained calcium phosphate crystals that were surrounded by microorganisms. Lacrimal sac concretion removal from the lacrimal sacs during dacryocystorhinostomies was performed on both patients. Although the postoperative outcome was favorable in one case, vision was lost in the other case due to the development of retinal artery occlusion as a complication of the orbital abscess, despite lacrimal sac concretion removal and administration of antimicrobials.Conclusions: This is the first case report to highlight that rebamipide ophthalmic suspension can cause an orbital abscess via development of lacrimal sac concretion. Ophthalmologists should be aware that rebamipide ophthalmic suspension might induce the formation of concretion in the lacrimal sac.

Rhino-Orbital mucormycosis in an immunocompetent pediatric patient with hyperglycemia of the hospitalized patient

Introduction: Acute invasive rhino-orbital mucormycosis usually affects diabetic or neutropenic patients, and only exceptionally develops in immunocompetent adults and children. Methodology: A 12-years-old immunocompetent female, presented with complicated rhinosinusitis with a subperiosteal orbital abscess, without improvement after initial medical and surgical management, the patient also developed hyperglycemia of the hospitalized patient that represented a challenging and potentially lethal clinical scenario. Results: Diagnosed with an unsuspected rhino-orbital mucormycosis by direct microscopy and PCR, she survived after amphotericin B and surgical treatment. Conclusions: In cases with torpid clinical evolution, even in apparently immunocompetent patients, appropriate multidisciplinary workup must be performed to rule out opportunistic etiologies including mucormycosis to improve survival.

Central Retinal Artery Occlusion Due to Subperiosteal Orbital Abscess Caused by Acute Sinusitis in a Child: A Case Report

Central retinal artery occlusion (CRAO) is an ophthalmic emergency and has poor visual prognosis. It is commonly found in elderly people and very rare in child. We reported an 8-year-old girl who suffered from acute sinusitis, periorbital swelling, and the visual acuity of her right eye was only light perception. She was diagnosed with CRAO, SPOA (subperiosteal orbital abscess), and acute sinusitis. Emergency treatments including surgery, antibiotics, glucocorticoids, intraocular-pressure-lowering drugs, and vasodilators were taken immediately in order to save the eyesight. The visual acuity of the right eye returned to 20/400. Conclusions: Severe intraorbital complications of acute sinusitis can lead to CRAO. Timely drainage, strong antibiotics, and glucocorticoids are the most effective methods for the treatments.