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Vikram D Durairaj - One of the best experts on this subject based on the ideXlab platform.

  • c reactive protein as a marker for initiating steroid treatment in children with Orbital Cellulitis
    Ophthalmic Plastic and Reconstructive Surgery, 2015
    Co-Authors: Brett W Davies, Eric M Hink, Jesse M. Smith, Vikram D Durairaj
    Abstract:

    PURPOSE: To determine both the benefit of systemic steroids in pediatric patients with Orbital Cellulitis and to assess the usefulness of C-reactive protein (CRP) levels as a marker for starting steroids. METHODS: Prospective, comparative interventional study. Pediatric patients aged 1 to 18 years admitted to a tertiary care children's hospital with a diagnosis of Orbital Cellulitis from October 2012 to March 2014 were included in the study. All patients were treated with intravenous antibiotics, and patients with subperiosteal abscess who met previously published criteria for surgical decompression underwent combined transOrbital drainage and/or endoscopic sinus surgery. CRP was measured daily as a biomarker of inflammation, and when below 4 mg/dl, patients were started on oral prednisone 1 mg/kg per day for 7 days. Patients whose families did not consent to steroid treatment served as the control group. Patients were followed after discharge until symptoms resolved and all medications were discontinued. RESULTS: Thirty-one children were diagnosed with Orbital Cellulitis during the study period. Of these 31 children, 24 received oral steroids (77%) and 7 did not (23%). There were 19 males and 5 females in the steroid group with an average age of 8.1 years, and 6 males and 1 female in the nonsteroid group with an average age of 7.1 years (p = 0.618). Thirteen patients (54%) in the steroid group and 2 patients (29%) in the nonsteroid group underwent sinus surgery with or without orbitotomy (p = 0.394). The average CRP at the onset of steroid treatment was 2.8 mg/dl (range: 0.5-4). Patients who received oral steroids were admitted for an average of 3.96 days. In comparison, patients who did not receive steroids were admitted for an average of 7.17 days (p < 0.05). Once CRP was ≤4 mg/dl, patients treated with steroids remained in the hospital for another 1.1 days, while patients who did not receive steroids remained hospitalized for another 4.9 days (p < 0.01). In the steroid group, 2 families reported increased hyperactivity in their children while on steroids. There was 1 case in each group of recurrence of symptoms after discharge from the hospital. Average follow-up time was 2.4 months in the steroid group and 2 months in the nonsteroid group (p = 0.996). At last visit, all patients returned to their baseline ophthalmic examination. There were no cases of vision loss or permanent ocular disability in either group. CONCLUSIONS: Our results give further evidence of the safety and benefit of systemic steroids in children with Orbital Cellulitis. Futhermore, this is the first study to suggest a standardized starting point (CRP ≤ 4 mg/dl) and dosing schedule (oral prednisone 1 mg/kg for 7 days) for children with Orbital Cellulitis. Patients who received systemic steroids after CRP dropped below 4 mg/dl were discharged from the hospital earlier than patients who did not receive systemic steroids.

  • predicting the need for surgical intervention in pediatric Orbital Cellulitis
    American Journal of Ophthalmology, 2014
    Co-Authors: Jesse M. Smith, Emily M Bratton, Peter E Dewitt, Eric M Hink, Brett W Davies, Vikram D Durairaj
    Abstract:

    Purpose To investigate the predictive value of the complete ophthalmic examination at first presentation in foreseeing the need for surgery in patients with pediatric Orbital Cellulitis. Design Retrospective observational case series. Methods We reviewed 136 cases of radiographically confirmed Orbital Cellulitis between 2004 and 2012 at Children's Hospital Colorado. The presenting ophthalmic examinations, imaging results, medical and surgical interventions, and clinical complications were recorded. The main outcome measures were ophthalmic examinations on presentation, medical or surgical interventions, and complications. Results The median age was 6.5 years. Of the patients, 56 (41%) underwent surgical intervention, and 80 patients (59%) were managed medically. Patients requiring surgery had higher rates of extraocular motility (EOM) restriction (78.6% vs 38.8% P P P P Conclusions In pediatric Orbital Cellulitis, the likelihood of surgical intervention can be estimated accurately based on the ophthalmic examination on initial presentation to the hospital. Risk factors for surgery include age older than 9 years, proptosis, EOM restriction, and elevated IOP. These factors may be used to identify patients at high risk for failure of medical management early in the clinical course.

  • atypical presentations of Orbital Cellulitis caused by methicillin resistant staphylococcus aureus
    Ophthalmology, 2012
    Co-Authors: Marc T Mathias, Michael B Horsley, Louise A Mawn, Stephen J Laquis, Kenneth V Cahill, Jill A Foster, Malena Amato, Vikram D Durairaj
    Abstract:

    Purpose To evaluate the epidemiologic and clinical features of Orbital Cellulitis caused by methicillin-resistant Staphylococcus aureus (MRSA). Design Multicenter, retrospective case series. Participants Fifteen patients with culture-positive MRSA Orbital Cellulitis. Methods All recent cases of Orbital Cellulitis at several hospitals and surgical centers were reviewed, and cases with culture-positive MRSA from aspirates were identified. The data collected and analyzed retrospectively included patient demographics, medical history, presenting sign, imaging results, surgical procedure performed, surgical culture results, visual acuity at presentation and last follow-up, and duration of antibiotics. Main Outcome Measures Presenting sign, radiographic evidence of paranasal sinus disease, radiographic evidence of multiple Orbital abscesses, presence or absence of antecedent upper respiratory infection, and final visual acuity. Results Fifteen cases were identified. The mean patient age was 31.9 years (standard deviation, 24.2 years). Lid swelling was the presenting sign in 14 of 15 patients. No patients had a preceding upper respiratory infection, and only 1 patient had antecedent eyelid trauma. Only 3 of 15 patients had documented adjacent paranasal sinus disease on imaging. Lacrimal gland abscess or dacryoadenitis was the presenting finding in 5 of 15 patients. Multiple Orbital abscesses were identified in 4 of 15 patients by computed tomography or magnetic resonance imaging. Fourteen of 15 cases required surgical intervention. Four of 15 cases had loss of visual acuity to light perception or worse. All 4 of these cases had a delay in referral for surgical intervention. Conclusions In these 15 patients with MRSA Orbital Cellulitis, the typical clinical setting of Orbital Cellulitis was absent; chiefly, there was no identified antecedent upper respiratory illness, nor was there a preceding traumatic injury. Lid swelling in the absence of recent upper respiratory illness, lacrimal gland focus, multiple Orbital abscesses, and lack of adjacent paranasal sinus disease may be predictive factors that suggest MRSA as the causative organism of Orbital Cellulitis. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Aaron M Miller - One of the best experts on this subject based on the ideXlab platform.

  • microbiology of pediatric Orbital Cellulitis
    American Journal of Ophthalmology, 2007
    Co-Authors: Steven H Mckinley, Aaron M Miller
    Abstract:

    Purpose To evaluate the microbiology of pediatric Orbital Cellulitis associated with sinusitis. Design Retrospective review of medical records of pediatric patients treated for Orbital Cellulitis. Methods All pediatric patients treated for Orbital Cellulitis associated with sinusitis at Texas Children's Hospital between December 1, 2001 and September 30, 2005 were reviewed. Data collected included patient age, history, microbiology results, and surgical intervention. Results Thirty-eight cases were identified. Fifteen cases required medical management, whereas 23 patients received a combination of medical and surgical intervention. Three patients had multiple surgical procedures performed. Of the procedures performed, four were sinus irrigation, 12 were sinusotomy and drainage, nine were orbitotomy with drainage of abscess, and one was craniotomy with drainage of abscess. Surgical aspirate specimens yielded a higher positive culture result rate with 9/9 of Orbital abscesses and 13/16 of sinus aspirates demonstrating a positive yield. Two of the 27 blood cultures had a positive yield. Staphylococcus species was the most common organism isolated. Methicillin-resistant S. aureus (MRSA) represented 73% of S. aureus isolates. Streptococcus species was the next most common pathogen. Three cultures yielded Haemophilus species with one being positive for H. influenzae . Conclusions Organisms responsible for causing pediatric Orbital Cellulitis are evolving, with Staphylococcus followed by Streptococcus species being the most common pathogens. The occurrence of MRSA in pediatric Orbital Cellulitis is increasing, and empiric antimicrobial therapy should be directed against these organisms if they are prevalent in the community. Sinus and Orbital abscess aspirates yielded the greatest number of positive cultures, though these invasive surgical procedures should be performed only when clinically indicated.

Tsunehiko Ikeda - One of the best experts on this subject based on the ideXlab platform.

  • c reactive protein may be useful to differentiate idiopathic Orbital inflammation and Orbital Cellulitis in cases with acute eyelid erythema and edema
    Clinical Ophthalmology, 2018
    Co-Authors: Yuko Nishikawa, Masahiro Tonari, Jun Sugasawa, Junko Matsuo, Tsunehiko Ikeda
    Abstract:

    Purpose: Idiopathic Orbital inflammation (IOI) and Orbital Cellulitis can present similar clinical features, and the diagnoses of these two disorders are sometimes confused. The purpose of the present study was to determine whether or not inflammatory markers in the blood can be useful to differentiate between IOI and Orbital Cellulitis in cases with acute eyelid erythema and edema. Subjects and methods: In this retrospective single-institute study, we reviewed the medical records spanning the past 10 years at the Department of Ophthalmology, Osaka Medical College Hospital, Takatsuki, Osaka, Japan, and found 45 cases, with patients >15 years of age, with presumed IOI. Their blood samples were obtained within 5 days after the onset of IOI. Of those cases, 15 patients (10 males, 5 females, mean age of 56.9 years; range 38-76 years) presented acute eyelid erythema and edema, and were initially misdiagnosed as Orbital Cellulitis. Thus, inflammatory markers in the blood (ie, white blood cells [WBCs] and C-reactive protein [CRP]) of those 15 patients were analyzed with 17 patients (10 males, 7 females) having Orbital Cellulitis. The receiver operating characteristic curve analysis was performed to determine the optimal cut-off values. Results: The mean ± standard error (SE) levels of the WBC were 6.80±0.70×103/μL in the IOI patients, and 8.54±0.91×103/μL in the Orbital Cellulitis patients, and no significant differences were observed (P=0.15, Student's t-test). However, the mean ± SE levels of CRP were 1.04±0.43 mg/dL in the IOI patients, yet were significantly increased to 4.65±1.21 mg/dL in the Orbital Cellulitis patients (P=0.01, Student's t-test). The area under the curve value was 0.80 and the optimal cut-off value was 0.43 for Orbital Cellulitis, with sensitivity and specificity being 82% and 73%, respectively. Conclusion: The findings of this study indicate that CRP may be useful in distinguishing patients with idiopathic Orbital inflammation from those with Orbital Cellulitis.

Jonathan C Horton - One of the best experts on this subject based on the ideXlab platform.

  • bilateral blindness from Orbital Cellulitis caused by community acquired methicillin resistant staphylococcus aureus
    American Journal of Ophthalmology, 2005
    Co-Authors: Tina Rutar, Orin M Zwick, Kimberly P Cockerham, Jonathan C Horton
    Abstract:

    PURPOSE: To describe bilateral blindness resulting from infection with community-acquired methicillin-resistant Staphylococcus aureus (MRSA). DESIGN: Observational case report. METHODS: A 44-year-old man developed proptosis, ptosis, ophthalmoplegia, and no light perception vision after attempting to lance a nasal pustule. A nasal culture grew MRSA. Imaging showed bilateral Orbital Cellulitis, pansinusitis, and cavernous sinus thrombosis. The right fundus showed severe ischemia, but the left fundus was essentially normal. RESULTS: Despite initiation of appropriate antibiotics early in the course of infection, the patient lost sight in both eyes. Surgical drainage of the paranasal sinuses and use of intravenous corticosteroids and heparin led to the resolution of Orbital Cellulitis. CONCLUSIONS: MRSA Orbital Cellulitis can progress to irreversible blindness despite antibiotic treatment. A new, community-acquired clone of this organism has exhibited increased potential for tissue invasion.

Yonca Ozkan Arat - One of the best experts on this subject based on the ideXlab platform.

  • the hot orbit Orbital Cellulitis
    Middle East African Journal of Ophthalmology, 2012
    Co-Authors: Imtiaz A Chaudhry, Waleed Alrashed, Yonca Ozkan Arat
    Abstract:

    Orbital Cellulitis is an uncommon condition previously associated with severe complications. If untreated, Orbital Cellulitis can be potentially sight and life threatening. It can affect both adults and children but has a greater tendency to occur in the pediatric age group. The infection most commonly originates from sinuses, eyelids or face, retained foreign bodies, or distant soources by hematogenous spread. It is characterized by eyelid edema, erythema, chemosis, proptosis, blurred vision, fever, headache, and double vision. A history of upper respiratory tract infection prior to the onset is very common especially in children. In the era prior to antibiotics, vision loss from Orbital Cellulitis was a dreaded complication. Currently, imaging studies for detection of Orbital abcess, the use of antibiotics and early drainage have mitigated visual morbidity significantly. The purpose of this review is to describe current investigative strategies and management options in the treatment of Orbital Cellulitis, establish their effectiveness and possible complications due to late intervention.

  • outcome of treated Orbital Cellulitis in a tertiary eye care center in the middle east
    Ophthalmology, 2007
    Co-Authors: Imtiaz A Chaudhry, Waleed Alrashed, Yonca Ozkan Arat, Farrukh A Shamsi, Elsanusi Elzaridi, Abdulrahman Alamri, Fahad Alanezi, David E E Holck
    Abstract:

    PURPOSE: To describe risk factors predisposing patients to Orbital Cellulitis and potential complications in patients treated at a tertiary eye care referral center in the Middle East. DESIGN: Noncomparative, interventional, retrospective case series. PARTICIPANTS: Patients diagnosed with Orbital Cellulitis. METHODS: A 15-year clinical review of patients with a diagnosis of Orbital Cellulitis referred to King Khaled Eye Specialist Hospital, an accredited (Joint Council on Accreditation of Healthcare Organizations, Washington, DC) tertiary care center in Riyadh, Saudi Arabia, was performed. Only those patients who had clinical signs and symptoms or radiologic evidence suggestive of Orbital Cellulitis were included in the study. MAIN OUTCOME MEASURES: Patient demographics, factors predisposing to Orbital Cellulitis, and resulting complications. RESULTS: A total of 218 patients (136 male, 82 female) fulfilling the diagnostic criteria for Orbital Cellulitis were identified. The average age of these patients was 25.7 years (range, 1 month-85 years). On imaging studies, there was evidence of inflammatory or infective changes to Orbital structures; Orbital abscesses were identified in 116 patients (53%). Sinus disease was the most common predisposing cause in 86 patients (39.4%), followed by trauma in 43 patients (19.7%). All patients received systemic antibiotic treatment before the identification of any responsible organisms. Of the 116 patients with Orbital abscess, 101 patients (87%) required drainage. The results of cultures in patients in whom an Orbital abscess was drained were positive for 91 patients (90%). The most common microorganisms isolated from the drained abscesses were Staphylococci and Streptococci species. Blood cultures were positive in only 4 patients from whom blood was drawn for cultures. Visual acuity improved in 34 eyes (16.1%) and worsened in 13 eyes (6.2%), including 9 (4.3%) eyes that sustained complete loss of vision, which was attributed to the delay in correct diagnosis and timely intervention (average 28 days vs. 9 days in patients with no loss of vision; P<0.05). There were 9 cases of intracranial extension of Orbital abscesses that required either extended treatment with systemic antibiotics alone or in combination with neurosurgical intervention. Most patients received oral antibiotics on discharge for varying periods. There were 6 cases (2.7%) of strabismus and 4 cases (1.8%) of ptosis that persisted after treatment and resolution of Orbital Cellulitis. CONCLUSIONS: Untreated sinusitis and prior history of Orbital trauma were the 2 major causes of Orbital Cellulitis in patients referred to a tertiary care eye center in the Middle East. Although rare, severe visual loss still remains a serious complication of delayed detection and intervention in most cases of Orbital Cellulitis.