RESUMEN
(Peri)orbital infections comprise a multitude of diagnoses, ranging from common hordeolum to rare but life-threatening necrotizing fasciitis. However, these disease entities are rarely diagnosed by an ophthalmic pathologist because (peri)orbital infections are usually diagnosed clinically, with the help of imaging and microbiological techniques when indicated. In this review article, the role of ophthalmopathology in the diagnosis of (peri)orbital infections is illustrated on the basis of several exemple diagnoses. An infectious hordeolum must be distinguished from a noninfectious chalazion. A nodular thickening of the eyelid, which is diagnosed and treated as a chalazion, can hide a malignant neoplasia. The correct diagnosis and treatment of canaliculitis is often delayed. In this context the most common causative organism, Actinomyces, can be depicted histologically, as can lacrimal stones/dacryoliths. Necrotizing fasciitis is a rapidly worsening infection of the fascia, which can lead to necrosis, sepsis, and death. During the Sars-CoV2 pandemic, an increased incidence of mucormycosis cases was observed, especially in India. This superinfection was facilitated by the widespread use of steroids and immunosuppression. Histologically, it is possible to visualize infiltration of vessel walls by the fungus. Ophthalmopathology contributes to the diagnosis and to understanding the pathophysiology of these diseases.
Asunto(s)
COVID-19 , Chalazión , Fascitis Necrotizante , Orzuelo , Enfermedades del Aparato Lagrimal , Chalazión/complicaciones , Chalazión/diagnóstico , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/terapia , Orzuelo/complicaciones , Orzuelo/diagnóstico , Humanos , ARN Viral , SARS-CoV-2RESUMEN
OBJECTIVE: To compare the curative effect between bloodletting at tip of ear with different amounts combined with western medication and western medication alone for early-stage stye. METHODS: A total of 108 patients with early-stage stye were randomly divided into a 50 µL group (36 cases, 4 cases dropped off), a 100 µL group (36 cases, 2 cases dropped off) and a western medication group (36 cases, 5 cases dropped off). The patients in the western medication group were treated with levofloxacin eye drops and levofloxacin hydrochloride eye gel. Based on the treatment of the western medication group, the patients in the 50 µL group were treated with 50 µL bloodletting (about 3 drops) at tip of ear while the patients in the 100 µL group were treated with 100 µL bloodletting (about 6 drops) at tip of ear; the bloodletting was given once a day for 3 days. After treatment, the changes of visual analogue scale (VAS) and clinical effect were observed, and the patients were followed up by telephone on the 8th day. RESULTS: After treatment, the VAS score in each group was reduced (P<0.01), and the score in the 50 µL group and 100 µL group was lower than that in the western medication group (P<0.05, P<0.01), and the score in the 100 µL group was lower than that in the 50 µL group (P<0.05). After treatment, the cured rate was 76.5% (26/34) in the 100 µL group, 71.9% (23/32) in the 50 µL group and 51.6% (16/31) in the western medication group, and there were no significant differences among three groups (P>0.05). One week after the onset of the disease, all the patients in the 50 µL group and 100 µL group were cured, and one patient in the western medication group was not cured, and treated with routine surgery. CONCLUSION: Based on the conventional western medication treatment, bloodletting at tip of ear can significantly reduce the pain of stye, and the effect of 100 µL bleeding is better than 50 µL.
Asunto(s)
Terapia por Acupuntura , Venodisección , Orzuelo , Manejo del Dolor , Puntos de Acupuntura , Orzuelo/complicaciones , Orzuelo/terapia , Humanos , Dolor , Resultado del TratamientoRESUMEN
BACKGROUND: Infestation by Demodex spp. in the palpebral edge follicles in humans is common. However, these mites are not routinely diagnosed in patients with or without ocular pathologies in Chile and their relevance is unclear. One of the eye diseases most related to infestation by Demodex spp. is blepharitis, a chronic inflammation of the eyelid margin with intermittent exacerbations, which is very common in ophthalmic practice. Its management is prolonged treatment, which is often ineffective, leading to relapses and frustration of patient and treating physician. Blepharitis can be typed by its etiology into various types, one of them is caused by Demodex folliculorum and another species, D. brevis. OBJECTIVE: The overall objective was to detect the presence and estimate the rate of infestation of Demodex spp. in healthy subjects and in patients with ocular pathology such as blepharitis, bacterial conjunctivitis, chalazion, and stye. PATIENTS AND METHODS: Samples of tabs from both lower eyelids of ophthalmologically healthy patients (23) and patients with ocular pathologies (9) were mounted in immersion oil as described in literature, then visualized with a 10x objective and confirmed with 40x objective. RESULTS: Detection rates of eggs, nymphs or adults of Demodex spp. in patients with and without ophthalmological problems were above and below 0.5 mites per tab, respectively. D.folliculorum was the species most frequently found. DISCUSSION: The results are consistent with the international literature on both the rate of infestation as the predominant species. CONCLUSION: This paper is the first study in Chile on this subject and represents a significant contribution to ophthalmic clinical diagnosis and treatment of patients with this disease.
Asunto(s)
Blefaritis/parasitología , Chalazión/parasitología , Conjuntivitis Bacteriana/complicaciones , Orzuelo/parasitología , Infestaciones por Ácaros/parasitología , Adolescente , Adulto , Factores de Edad , Anciano , Animales , Blefaritis/complicaciones , Estudios de Casos y Controles , Chalazión/complicaciones , Niño , Enfermedad Crónica , Estudios Transversales , Femenino , Orzuelo/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Infestaciones por Ácaros/complicaciones , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
Infestation by Demodex spp. in the palpebral edge follicles in humans is common. However, these mites are not routinely diagnosed in patients with or without ocular pathologies in Chile and their relevance is unclear. One of the eye diseases most related to infestation by Demodex spp. is blepharitis, a chronic inflammation of the eyelid margin with intermittent exacerbations, which is very common in ophthalmic practice. Its management is prolonged treatment, which is often ineffective, leading to relapses and frustration of patient and treating physician. Blepharitis can be typed by its etiology into various types, one of them is caused by Demodex folliculorum and another species, D. brevis. Objective: The overall objective was to detect the presence and estimate the rate of infestation of Demodex spp. in healthy subjects and in patients with ocular pathology such as blepharitis, bacterial conjunctivitis, chalazion, and stye. Patients and Methods: Samples of tabs from both lower eyelids of ophthalmologically healthy patients (23) and patients with ocular pathologies (9) were mounted in immersion oil as described in literature, then visualized with a 10x objective and confirmed with 40x objective. Results. Detection rates of eggs, nymphs or adults of Demodex spp. in patients with and without ophthalmological problems were above and below 0.5 mites per tab, respectively. D.folliculorum was the species most frequently found. Discussion: The results are consistent with the international literature on both the rate of infestation as the predominant species. Conclusion: This paper is the first study in Chile on this subject and represents a significant contribution to ophthalmic clinical diagnosis and treatment of patients with this disease.
La infestación por Demodex spp. en los folículos del borde palpebral en humanos es frecuente; no obstante, en Chile no se diagnostica de rutina la presencia de estos ácaros en pacientes sin o con patologías oculares por lo cual no se conocen aspectos de esta parasitosis. Una de las patologías oculares que más se relaciona con infestación por Demodex spp. es la blefaritis, enfermedad muy común en la práctica oftalmológica, que cursa con inflamación crónica del borde palpebral, con exacerbaciones intermitentes de los síntomas. Su manejo suele llevar mucho tiempo frecuentemente ineficaz, con múltiples recaídas que terminan desmoralizando al paciente y, al médico que las trata. De acuerdo a la etiología, se caracterizan varios tipos de blefaritis y una de ellas es asociada a Demodexfolliculorum, existiendo también la especie D. brevis. Objetivo: Detectar la presencia y calcular el índice de infestación de Demodex spp. en pacientes sanos y en pacientes con alguna patología ocular como blefaritis crónica, conjuntivitis bacteriana, chalazión y orzuelo. Pacientes y Métodos: Se tomaron muestras de pestañas desde el párpado inferior de ambos ojos en pacientes oftalmológicamente sanos23 y pacientes con patologías oculares9 las que fueron montadas en aceite de inmersión según técnica descrita en la literatura, visualizadas con objetivo 10x y confirmadas con objetivo 40x. Resultados: Se encontró la presencia de huevos, ninfas y ejemplares adultos de D. folliculorum y D. brevis, tanto en pacientes normales como en pacientes oftalmológicos siendo el índice de infestación menor a 0,5 ácaros por pestaña en los pacientes sanos y mayor o igual a 0,5 en pacientes oftalmológicos. La especie más frecuentemente encontrada fue D. folliculorum. Discusión: Los resultados encontrados coinciden con la literatura internacional tanto en el índice de infestación como en la especie predominante. Conclusión: Este trabajo constituye el primero realizado en Chile en esta temática, de acuerdo a la literatura revisada, lo cual constituye un gran aporte al diagnóstico clínico oftalmológico con implicancias en el tratamiento de estos pacientes.
Asunto(s)
Adolescente , Adulto , Anciano , Animales , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Blefaritis/parasitología , Chalazión/parasitología , Conjuntivitis Bacteriana/complicaciones , Orzuelo/parasitología , Infestaciones por Ácaros/parasitología , Factores de Edad , Blefaritis/complicaciones , Estudios de Casos y Controles , Enfermedad Crónica , Estudios Transversales , Chalazión/complicaciones , Orzuelo/complicaciones , Infestaciones por Ácaros/complicaciones , Índice de Severidad de la EnfermedadAsunto(s)
Conjuntivitis/diagnóstico , Conjuntivitis/terapia , Blefaritis/complicaciones , Chalazión/complicaciones , Varicela/complicaciones , Conjuntivitis/etiología , Conjuntivitis Hemorrágica Aguda/diagnóstico , Conjuntivitis Hemorrágica Aguda/terapia , Conjuntivitis Alérgica/diagnóstico , Conjuntivitis Alérgica/terapia , Conjuntivitis Bacteriana/diagnóstico , Conjuntivitis Bacteriana/terapia , Conjuntivitis Viral/diagnóstico , Conjuntivitis Viral/terapia , Dermatitis Atópica/complicaciones , Diagnóstico Diferencial , Tratamiento de Urgencia , Oftalmopatías/diagnóstico , Oftalmopatías/terapia , Glaucoma/complicaciones , Orzuelo/complicaciones , Humanos , Queratitis/complicaciones , Queratoconjuntivitis/diagnóstico , Queratoconjuntivitis/terapia , Enfermedades del Aparato Lagrimal/complicaciones , Síndrome Mucocutáneo Linfonodular/complicaciones , Trastornos de la Motilidad Ocular/complicaciones , Celulitis Orbitaria/complicaciones , Síndrome de Stevens-Johnson/complicaciones , Uveítis/complicacionesRESUMEN
A 21-year-old female with West syndrome was scheduled for resection of hordeolum. She had an episode of convulsion at three months of age, and was diagnosed as having West syndrome at one year of age. She had epileptic seizures twice a week in spite of administration of phenytoin, clonazepam and sodium valproate. These drugs had been administered till the morning of the surgery. After premedication with atropine 0.25 mg, anesthesia was induced with propofol (12-->10-->8 mg.kg-1.h-1). The tracheal intubation was performed with vecuronium 0.1 mg.kg-1 and anesthesia was maintained with continuous infusion of propofol 6-8 mg.kg-1.h-1 and local infiltration with 1.0% lidocaine 5 ml. We administered phenytoin to prevent epileptic seizures during the surgery. No epileptic seizures occurred perioperatively. We conclude that propofol may be useful for a patient with West syndrome, and we should be careful not to lower the threshold for convulsion during the perioperative period.
Asunto(s)
Anestesia Intravenosa , Atención Perioperativa , Espasmos Infantiles , Adulto , Anestésicos Intravenosos , Anticonvulsivantes/administración & dosificación , Epilepsia/prevención & control , Femenino , Orzuelo/complicaciones , Orzuelo/cirugía , Humanos , Complicaciones Intraoperatorias/prevención & control , Fenitoína/administración & dosificación , Propofol , Espasmos Infantiles/complicacionesAsunto(s)
Orzuelo/complicaciones , Sepsis/etiología , Infecciones Estafilocócicas/etiología , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Femenino , Orzuelo/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Sepsis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológicoAsunto(s)
Seno Cavernoso , Trombosis/etiología , Niño , Femenino , Orzuelo/complicaciones , Humanos , LactanteRESUMEN
Fibrous histiocytoma is a rare tumor whose ocular manifestations usually involve the orbit or, less commonly, the conjunctiva and ciliary body. We have treated two patients with fibrous histiocytoma of the lacrimal sac. One, a 62-year-old woman who had had hordeolum and trachoma, had a visual acuity of counting fingers at 1 m in the affected eye. The fellow eye had been enucleated ten years previously. The entire lacrimal sac was surgically removed and a brown cystic tumor measuring 28 x 12 x 10 mm was found. The second patient, a 32-year-old man, had undergone an unsuccessful dacryocystectomy for epiphora. When he underwent a dacryocystorhinostomy some months later, a mass measuring 20 x 15 x 12 mm was found in the wall of the lacrimal sac. Microscopic examination of the two excised lacrimal sacs showed that the walls were thickened by cells resembling fibroblasts and by cells resembling histiocytes. The fibroblasts were characterized by collagen production, were fusiform or oval in shape, and were arranged in bundles. The histiocytes were larger and had abundant (and sometimes vacuolated) cytoplasm. All the cells appeared to be mature.
Asunto(s)
Histiocitoma Fibroso Benigno/cirugía , Enfermedades del Aparato Lagrimal/cirugía , Neoplasias Orbitales/cirugía , Adulto , Femenino , Histiocitoma Fibroso Benigno/patología , Orzuelo/complicaciones , Humanos , Enfermedades del Aparato Lagrimal/complicaciones , Enfermedades del Aparato Lagrimal/patología , Obstrucción del Conducto Lagrimal/complicaciones , Masculino , Persona de Mediana Edad , Neoplasias Orbitales/patología , Tracoma/complicacionesRESUMEN
The paper describes a case of osteomyelitis of the frontal bone after exeresis of the first trigeminal branch, which was postoperatively precipitated probably by chronically relapsing hordeola. General principles of skull-cap osteomyelitis are discussed, and conclusions are drawn form the case describe in the paper.