Orbital cellulitis is a medical emergency requiring multidisciplinary team involvement. Early diagnosis and intervention is imperative to avoid serious complications. This article provides an evidence-based approach to the assessment and management of patients with orbital cellulitis.
Perhaps most importantly the mechanism of disease transmission remains, as judged by expert groups, to be predominantly via contact (fomite) and droplet infection with airborne infection judged only a minor contributor.
Purpose:The purpose of this study was to describe an indirect corneal neurotization (CN) technique for congenital bilateral trigeminal anesthesia using the greater auricular nerve (GAN) as a donor.Method: CN was performed to preserve the integrity of the only seeing eye in a 4-year-old boy with pontine tegmental cap dysplasia and bilateral trigeminal anesthesia. He had recurrent corneal ulceration and scarring despite full medical treatment. The GAN was used as a donor, and the sural nerve was harvested and used as a bridge which was tunneled to the sub-Tenon space in the inferior fornix. The fascicles were distributed into the 4 quadrants and sutured to the sclera near the limbus.Result: This technique resulted in providing corneal sensation and improving stability of the epithelium. Corneal opacity gradually decreased allowing significant visual improvement evidenced in the early postoperative months.
Conclusions: Using the GAN technique for CN bypasses tri-geminal innervation and has the potential to improve corneal sensation. The GAN is a large caliber nerve and provides a large amount of axons and robust neurotization. This technique would be desirable for cases with bilateral congenital trigeminal anesthesia, such as pontine tegmental cap dysplasia.
ImportanceOphthalmic manifestations occur in less than 5% of patients with human mpox (monkeypox), most commonly presenting with self-limiting conjunctivitis and keratitis. Cases with severe ophthalmic complication are uncommon.ObjectiveTo present a case of human mpox with sight-threatening necrotizing blepharoconjunctivitis.Design, Setting, and ParticipantsThis is a report of a patient who developed necrotizing conjunctivitis due to the monkepox virus at a large university hospital. Data were collected from July to October 2022.Main Outcomes and MeasuresDescription of the progression and clinical evaluation of the ocular condition and the management.ResultsA 63-year-old HIV-positive man presented initially with conjunctivitis and eyelid swelling and developed skin lesions from monkeypox virus 2 days later. Despite remaining stable systemically, after 4 days, his ophthalmic condition evolved to necrotizing blepharoconjunctivitis for which systemic antiviral treatment with tecovirimat was given along with topical trifluoridine, 1%, eye drops. In addition, he required repeated tissue debridement with amniotic membrane grafting to preserve the eye integrity.Conclusions and RelevanceThe severity of this observation was associated with a coexisting immunocompromised state and appeared similar to findings associated with other orthopoxviruses. Ophthalmic manifestations could be the initial presentation of human mpox and could also be severe. Early recognition and intervention may limit the likelihood of substantial ocular morbidity.
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