Orbital cellulitis following surgery of strabismus

The authors report a case of orbital cellulitis after strabismus surgery. Diagnosis was confirmed by computerized tomography. Subsequent therapy and follow-up are discussed. Attention is drawn to the importance of this syndrome.     

Acute hypocomplementemic post-infectious glomerulonephritis as a complication of sinus-related orbital cellulitis: case report

Group A beta-hemolytic streptococcus is the most common agent implicated in post-infectious acute glomerulonephritis. We report a case of acute poststreptococcal glomerulonephritis associated with sinus-related orbital abscess in an 11-year-old boy treated with surgical drainage and intravenous ceftriaxone and clindamycin. Twelve days after supportive measures, renal function was normalized. We also discuss this potentially severe nonsuppurative complication of orbital cellulitis caused by group A beta-hemolytic streptococcus.     

Giant orbital cysts after strabismus surgery

PURPOSE: To describe a rarely reported complication of strabismus surgery. DESIGN: Observational case series. METHODS: A review of four eyes in three patients with orbital cysts following strabismus surgery. RESULTS: Each patient had either a symptomatic strabismus or visible mass that brought them to medical attention many years, often decades after surgery (mean 34 years). All had some degree of incomitancy. During surgery, all cysts were found to be associated with the involved rectus muscle. CONCLUSIONS: Orbital cysts are a rarely recognized complication of strabismus surgery. However, it should be considered in the differential of orbital cysts after strabismus surgery because of the risk of muscle damage during surgical excision.     

Unusual complication of strabismus and lid surgery

A patient with longstanding dysthyroid eye disease developed a broad adhesion between the globe and the upper eyelid following simultaneous surgery to recess the levator palpebrae superioris and lateral rectus muscles. This unusual complication may have developed as a consequence of failure to suture the conjuctiva of the upper fornix to the tarsus and also due to the prolonged static contact between the resulting adjacent raw areas due to postoperative eyelid traction and pressure dressings. Periods of such contact may have been further prolonged by the action of diazepam, which reduces the peak velocity of saccadic eye movements and suppresses rapid eye movement of sleep. Eyelid surgery should be performed as a separate procedure, under local anesthetic after healing of areas bare of conjunctiva from strabismus surgery utilizing the adjustable suture technique.     

Giant orbital cyst after strabismus surgery.

We describe the clinical, histopathologic, and radiologic findings and management of a patient who had a giant orbital cyst after reoperative strabismus surgery. In the case report, we describe, in detail, a giant orbital cyst developing on the medial side of the globe after the third operation for repair of strabismus. Imaging studies, including computed tomographic (CT) scan and orbital ultrasound, demonstrate the findings. The observations at surgery and the surgical pathologic condition of the cyst are described. The orbital cyst was successfully removed, advancing the remaining medial rectus muscle and recessing the lateral rectus muscle, which resulted in reduction of a large-angle exotropia to a small exodeviation. Adduction was improved but not normalized. The pathologic examination indicated a benign inclusion cyst of the conjunctiva with fibrosis and chronic inflammation. A possible cause of this type of cyst is an epithelial remnant inadvertently placed with the muscle substance during previous surgery.     

Delayed orbital hemorrhage after routine strabismus surgery

PURPOSE: To report a case of delayed rectus muscle hemorrhage after strabismus surgery. METHODS: Case report. RESULTS: Rectus muscle hemorrhage occurred 36 hours after strabismus surgery in a 26-year-old man, causing temporary loss of vision and reduced ocular motility. Urgent lateral cantholysis and orbital exploration to restore hemostasis were undertaken. Full recovery of vision occurred and a small residual motility disturbance was present 3 months postoperatively. CONCLUSION: Delayed rectus muscle hemorrhage poststrabismus surgery is rare but can have sight-threatening effects. When vision is threatened because of optic nerve compromise, urgent orbital exploration may allow full recovery of function.     

Orbital cellulitis complicating strabismus surgery: a case report and review of the literature.

Orbital cellulitis is a rarely reported, but potentially vision- and life-threatening complication after strabismus surgery. To date, only seven cases of orbital cellulitis complicating strabismus surgery have been reported in the world literature, and only two cases were reported in adult patients, both occurring more than 100 years ago. We describe a case of unilateral orbital cellulitis after bilateral strabismus surgery in an adult. Early diagnosis (aided by computed tomography) and aggressive intravenous antibiotic therapy resulted in a favorable visual outcome. Diagnosis and management are discussed, and this case is compared with previous cases in the literature.     

Orbital cellulitis as a postoperative complication of sub-Tenon anaesthesia in cataract surgery

Orbital cellulitis is a rarely reported sight-threatening complication of sub-Tenon anaesthesia. We report a case of orbital cellulitis in a patient who had received sub-Tenon anaesthesia for routine cataract surgery. We discuss the potential under-reporting of complications of sub-Tenon anaesthesia that had a delayed presentation, and the possible association between the use of hyaluronidase in the anaesthetic mixture and orbital cellulitis following sub-Tenon anaesthesia.     

Anaerobic orbital cellulitis

A 10-year-old boy with orbital cellulitis died seven weeks after admission to the hospital despite intensive surgical intervention and medical therapy. We isolated many anaerobic bacteria from the orbit, frontal sinus, and epidural space. Orbital cellulitis, which often occurs by direct extension from infected paranasal sinuses, commonly affects children and young adults, and is a potentially lethal disease, if left untreated. Heightened awareness of the role of anaerobes in chronic sinusitis and of the possibility of an anaerobic orbital cellulitis may lead to the identification of more cases. Penicillin G appears to be the first drug of choice in cases with suspected anaerobic orbital cellulitis. Chloramphenicol and clindamycin should be considered, if treatment with penicillin fails. Antibiotics alone should not be considered as a panacea, and surgical drainage is often the most compelling consideration.