Periocular and anterior orbital necrosis after upper eyelid gold weight loading: operation-related or self-inflicted?

Abstract

A 44-year-old woman, who had undergone gold-weight implantation due to facial palsy and lagophthalmos, arrived at the ophthalmology ward with eyelid swelling and erythema, which rapidly deteriorated under intravenous antibiotics to a necrotic process involving the periocular tissues, the eye, and the anterior orbit. Despite prompt removal of the gold weight, the patient’s ocular and systemic condition continued to deteriorate, necessitating evisceration and debridement of necrotic tissue. Cultures showed growth of Staphylococcus epidermidis, Staphylococcus capitis, Candida glabrata, and Candida albicans, and histopathology demonstrated an acute nonspecific necrotizing panophthalmitis. Later on, the patient was admitted to a plastic surgery ward with recurrent severe burns of her thigh, which were highly suggestive of being self-induced, raising the possibility of self-induced damage.

Staphylococcus capitis: Review of Its Role in Infections and Outbreaks

“…Within adults, S. capitis infection has resulted in a number of different clinical presentations. These include the following: Native valve endocarditis [ 48 , 49 , 50 , 51 , 52 ]; Prosthetic valve endocarditis [ 53 , 54 , 55 , 56 , 57 , 58 ]; Osteomyelitis [ 59 , 60 , 61 , 62 ]; Polymicrobial infections [ 63 , 64 , 65 , 66 ]; Surgical implant infections [ 67 , 68 , 69 , 70 , 71 ]; …”

“…For endocarditis, vancomycin plus gentamicin in the presence of a prosthetic valve or rifampicin with a native valve was common [ 50 , 51 , 52 , 54 , 55 , 56 , 57 , 58 ]. Other commonly used antibiotics have included meropenem and clindamycin in implant/device-related infections [ 67 , 68 , 69 , 70 , 71 ]. With the exception of cases of native valve endocarditis ( n = 4), where 50% of patients died ( n = 2) and the remaining had long-term complications ( n = 2) [ 50 , 51 , 52 ], S. capitis infection in other sites resolved using the described management.…”