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P. Luke, A. Song; Concurrent Endophthalmitis And Orbital Cellulitis: A Review Of Clinical Features, Predisposing Factors, And Outcomes . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5283.
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To review reported cases documenting the coexistence of endophthalmitis and/or panophthalmitis with orbital cellulitis.
A systematic review was performed on reported cases involving concurrent endophthalmitis and/or panophthalmitis with orbital cellulitis. Cases were then categorized into exogenous or endogenous causes of disease and reviewed for clinical presentations, predisposing conditions, underlying mechanisms, isolated organisms, treatment protocol, and final outcomes.
Seven cases involved endogenous spread from an underlying medical condition. These included disseminated pulmonary blastomycosis, subacute bacterial endocarditis, Pseudomonas septicemia secondary to myelodysplastic syndrome, metastasis secondary to Pseudomonas septicemia from severe burns, diabetes mellitus with neovascular glaucoma, perforated Herpes simplex keratitis, and diabetes with methicillin–resistant Staphylococcus aureus. The remaining four cases involved exogenous causes of infection including phacoemulsification with sub–tenon's anesthesia, radial keratotomy, penetrating corneal trauma, and post–trabeculectomy blebitis. Seven cases involved the right eye and four cases involved the left eye. A total of eight cases required enucleation. Three cases resolved on appropriate antibiotics and steroids.
Although a rare occurrence, the coexistence of endophthalmitis and/or panophthalmitis with orbital cellulitis portends a very poor prognosis, especially for those with concomitant conditions predisposing to immunosuppression. Thus, it is essential to recognize risk factors and to initiate aggressive treatment once the diagnosis has been established.
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