This article describes a technique of dacryocystectomy involving dissection within the subfascial plane, in which the lacrimal sac fascia is preserved and the orbital fat remains undisturbed. The ...lacrimal sac cavity was directly injected with Tisseel fibrin glue mixed with trypan blue. This led to sac distension and facilitated its separation from surrounding periosteal and fascial attachments. Staining the lacrimal sac epithelium improved definition of the mucosal lining. Transverse sections of the lacrimal sac specimen were histologically analyzed, which confirmed that dissection was completed within a subfascial plane. The technique herein described facilitates en bloc excision of the lacrimal sac without breaching the fascial plane that separates the sac from orbital fat.
Acute dacryocystitis is a common condition occurring secondary to nasolacrimal duct obstruction. We aim to assess the efficacy of primary dacryocystorhinostomy for the management of acute ...dacryocystitis.
A systematic search of the databases PubMed/MEDLINE, Embase, and CENTRAL was performed to December 2023. Data extraction and risk of bias analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Fourteen articles fulfilled inclusion criteria. The results demonstrated that for the treatment of acute dacryocystitis, primary dacryocystorhinostomy (DCR) is anatomically and functionally efficacious, with low complication rates and minimal risk of recurrence. The anatomical success rates for primary endonasal DCR (EnDCR) were 81.8-100%, 83.8-87.5% in delayed EnDCR and 66-100% in delayed external DCR (ExDCR). Functional success was generally defined as a subjective absence of epiphora, which was achieved in 86.4-92.0% of primary EnDCR, and 0-89.5% of the delayed ExDCR cohorts. Two randomized controlled trials established equivalent rates of functional success between primary versus delayed EnDCR (87.5% vs 87.5% and 91.3% vs 92.3%). Increased perioperative bleeding was recorded in 27.8% of primary EnDCR cases in 1 study. ExDCR was infrequently associated with postoperative fistula and scar formation and cicatricial punctal ectropion. The mean length of admission trended to be shorter when the procedure was performed closer to the acute presentation. The admission time for all primary EnDCR cases varied between 1 and 7 days.
Primary dacryocystorhinostomy is an efficacious and safe management option for acute dacryocystitis. Further analyses of health-economics are required.
We performed a comprehensive systematic review to identify medication-associated orbital inflammation and to characterize its clinico-radiological features. We reviewed English-language articles ...describing medication-associated orbital inflammation (i.e., orbital myositis, dacryoadenitis and orbital fat) published to June, 2023. Isolated inflammation of the intraocular structures or globe alone (i.e. uveitis, scleritis, optic neuritis and perineuritis) were excluded. In medication-associated orbital inflammation, the extraocular muscles are preferentially affected, occurring in isolation or in combination with other orbital and/or intraocular structures. Clinico-radiological manifestations may be non-specific; however, certain medications may be distinguished according to the presence of systemic prodrome, laterality, associated intraocular inflammation, and predisposition to involve certain orbital structures. Rapid identification, discontinuation of the provoking medication, and systemic corticosteroid therapy (if appropriate) typically achieves a favorable visual prognosis. As new medications become adopted by clinicians, rare adverse effects will be further delineated.Medication-associated orbital inflammation is an important diagnostic consideration in orbital inflammatory disease. A careful medication history and clinical assessment may be revealing, permitting timely discontinuation of the offending agent and initiation of appropriate management.
Purpose
To provide a comprehensive microbiological profile of bacterial dacryocystitis in South Australia. By identifying the specific microorganism and antibiotic susceptibility, this study intends ...to aid ophthalmologists in choosing appropriate empirical antibiotic therapies and development of evidence-based clinical guidelines.
Method
A retrospective study was conducted at the Royal Adelaide Hospital (RAH) over five years (2018–2023) of patients with acute dacryocystitis. The study included 43 patients, and data encompassed demographic information, clinical presentation, microbiological analysis, management, and outcomes. Patients with chronic dacryocystitis were excluded.
Results
Among the 43 patients included in the study (female 28 (65%), mean age: 64 years old), the most common clinical features were pain (74%) and swelling (70%). Organisms were identified in 49% of patients, with the predominant bacteria being
Staphylococcus aureus
(42%),
Streptococcus
species (19%), and
Escherichia coli
(8%).
Aggregatibacter
species (8%),
Morganella morganii
(4%),
Enterobacter cloaceae
(4%),
Hafnia alvei
(4%), mixed anaerobes (4%),
E coliforms
(4%) and
Pseudomonas aeruginosa
(4%) were also identified. The most frequently prescribed empirical antibiotics were amoxicillin-clavulanic acid (50%), flucloxacillin (33%) and cefalexin (18%).
Conclusion
The microbiological trends of acute dacryocystitis have largely remained consistent, with a predominance of Gram positive organisms. This is the most recent profile analysis of acute dacryocystitis in South Australia and will help form evidence-based clinical guidelines.
Periocular squamous cell carcinoma is a common cutaneous malignancy with generally favorable outcomes; however, the periocular region is intrinsically a high-risk location, and there exist a subset ...of lesions with a propensity for poor outcomes. Orbital invasion, intracranial perineural spread, nodal and distant metastasis are feared complications. There are several staging systems for eyelid carcinoma and cutaneous squamous cell carcinoma, but the definition of high-risk lesions remains heterogeneous. It is unclear exactly which lesions can be safely deescalated, and which require nodal evaluation and adjuvant multimodal therapy. We seek to answer these questions by summarizing the literature on clinicopathologic variables, molecular markers, and gene profiling tests in periocular squamous cell carcinoma, with the extrapolation of data from the cutaneous squamous cell carcinoma literature. Standardized pathology reports with information on tumor dimensions, histological subtype and grade, perineural invasion, and lymphovascular invasion should become uniform. Integration with gene expression profiling assessments will individualize and improve the predictive accuracy of risk stratification tools to ultimately inform multidisciplinary decision-making.
Purpose
This study describes the microbiology of bacterial orbital cellulitis (OC) over an 11-year period and its clinical associations at three tertiary institutions in Adelaide, South Australia.
...Methods
Multi-centre retrospective study of the microbiology of bacterial OC between January 2012 and August 2022. Pre-septal cellulitis was excluded. Differences in means were determined by the Independent Samples
t
-test, and categorical data was analysed via Pearson’s Chi square. A
P
-value < 0.05 was statistically significant.
Results
99 patients (male: 69, mean age: 22.0 ± 23.8 years old), of which 70.7% were aged ≤ 18 years. Sinus and orbital abscess cultures had the greatest positive yield (73.7%). Frequency of organisms:
Streptococcus
species (34.3%),
Staphylococcus aureus
(28.3%),
Haemophilus
species (5.1%), mixed anaerobes (3.0%),
Enterobacter cloacae
(2.0%),
Moraxella catarrhalis
(1.0%),
Pseudomonas aeruginosa
(1.0%),
Corynebacterium
species (1.0%),
Klebsiella pneumoniae
(1.0%),
Proteus mirabilis
(1.0%)
, Citrobacter koseri
(1.0%), and
Enterococcus
species (1.0%).
Streptococcus
species predominated in the paediatric population, with a statistically significant difference in mean age between
Streptococcus
species and
Staphylococcus aureus
(14.1 ± 16.5 vs 27.6 ± 24.6 years old, respectively) (
P
= 0.028). No organism was cultured in 32.3% of cases. Methicillin-resistant
Staphylococcus aureus
(MRSA) accounted for 28.6% of all
Staphylococcus aureus
isolates, with 50% occurring between 2021 and 2022.
Conclusion
Yearly microbiological trends have remained largely constant in South Australia. The causative organism was not identified in 32.3% of cases, further emphasising appropriate empirical antibiotics, and obtaining microbiology from various sources. MRSA OC remains of increased clinical and public health concern and may be associated with a more aggressive disease course.
IgG4-related disease is an uncommon multisystem inflammatory disease characterized by tissue infiltration by IgG4 plasma cells, extensive fibrosis, and sclerosing inflammation. Diffuse orbital ...involvement extending to the orbital apex and cavernous sinus has been reported, but a solitary well-circumscribed lesion at the apex has not been previously reported. Herein, we report a unique case of IgG4-related orbital disease presenting as a solitary well-circumscribed orbital apex lesion causing subacute visual decline in a 45-year-old male. MRI demonstrated bilateral lacrimal gland and infraorbital nerve enlargement and an 18 × 7 mm left orbital apex lesion demonstrating homogeneous contrast enhancement and isointense signal on T2. He was initially treated with tapering systemic corticosteroid therapy with improvement in his vision; however, he experienced visual deterioration 3 months later with recurrent inflammation. He subsequently commenced high-dose systemic corticosteroid therapy and rituximab infusions with improvement of left visual acuity to 6/7.5 + 2.
