Focus on Ophthalmopathology – Orbital Infections from Hordeolum to Necrotizing Fasciitis

Abstract

(Peri)orbital infections comprise a multitude of diagnoses, ranging from common hordeolum to rare but life-threatening necrotizing fasciitis. However, these disease entities are rarely diagnosed by an ophthalmic pathologist because (peri)orbital infections are usually diagnosed clinically, with the help of imaging and microbiological techniques when indicated. In this review article, the role of ophthalmopathology in the diagnosis of (peri)orbital infections is illustrated on the basis of several exemple diagnoses. An infectious hordeolum must be distinguished from a noninfectious chalazion. A nodular thickening of the eyelid, which is diagnosed and treated as a chalazion, can hide a malignant neoplasia. The correct diagnosis and treatment of canaliculitis is often delayed. In this context the most common causative organism, Actinomyces, can be depicted histologically, as can lacrimal stones/dacryoliths. Necrotizing fasciitis is a rapidly worsening infection of the fascia, which can lead to necrosis, sepsis, and death. During the Sars-CoV2 pandemic, an increased incidence of mucormycosis cases was observed, especially in India. This superinfection was facilitated by the widespread use of steroids and immunosuppression. Histologically, it is possible to visualize infiltration of vessel walls by the fungus. Ophthalmopathology contributes to the diagnosis and to understanding the pathophysiology of these diseases.

Key words

orbit - infectious diseases - pathology

Publication History

Received: 27 November 2021

Accepted: 27 February 2022

Article published online:
20 July 2022

• References/Literatur

• 1 Vernon SA. Analysis of all new cases seen in a busy regional centre ophthalmic casualty department during 24-week period. J R Soc Med 1983; 76: 279-282
• 2 Channa R, Zafar SN, Canner JK. et al. Epidemiology of Eye-Related Emergency Department Visits. JAMA Ophthalmol 2016; 134: 312-319
• 3 Ramsay C, Murchison AP, Bilyk JR. Pediatric Eye Emergency Department Visits: Retrospective Review and Evaluation. J Pediatr Ophthalmol Strabismus 2021; 58: 84-92
• 4 Murphy C, Livingstone I, Foot B. et al. Orbital cellulitis in Scotland: current incidence, aetiology, management and outcomes. Br J Ophthalmol 2014; 98: 1575-1578
• 5 Ivanišević M, Ivanišević P, Lešin M. Epidemiological characteristics of orbital cellulitis among adult population in the Split region, Croatia. Wien Klin Wochenschr 2019; 131: 205-208
• 6 Verdijk RM, Pecorella I, Mooay CM. The Orbit, including the lacrimal Gland and lacrimal Drainage System. In: Heegaard S, Grossniklaus H. eds. Eye Pathology. Berlin, Heidelberg: Springer; 2015: 550-553
• 7 Wai KM, Locascio JJ, Wolkow N. Bacterial dacryoadenitis: clinical features, microbiology, and management of 45 cases, with a recent uptick in incidence. Orbit 2021; 29: 1-9
• 8 Luemsamran P, Rootman J, White VA. et al. The role of biopsy in lacrimal gland inflammation: A clinicopathologic study. Orbit 2017; 36: 411-418
• 9 Briscoe D, Edelstein E, Zacharopoulos I. et al. Actinomyces canaliculitis: diagnosis of a masquerading disease. Graefes Arch Clin Exp Ophthalmol 2004; 242: 682-686
• 10 Yuksel D, Hazirolan D, Sungur G. et al. Actinomyces canaliculitis and its surgical treatment. Int Ophthalmol 2012; 32: 183-186
• 11 Vécsei VP, Huber-Spitzy V, Arocker-Mettinger E. et al. Canaliculitis: difficulties in diagnosis, differential diagnosis and comparison between conservative and surgical treatment. Ophthalmologica 1994; 208: 314-317
• 12 Alam MS, Poonam NS, Koka K. et al. Intracanalicular antibiotic ointment loading as a management option for canaliculitis. Orbit 2021; 40: 295-300
• 13 Shih EJ, Chen JK, Tsai PJ. et al. Differences in characteristics, aetiologies, isolated pathogens, and the efficacy of antibiotics in adult patients with preseptal cellulitis and orbital cellulitis between 2000–2009 and 2010–2019. Br J Ophthalmol 2021;
• 14 Tsirouki T, Dastiridou AI, Ibánez Flores N. et al. Orbital cellulitis. Surv Ophthalmol 2018; 63: 534-553
• 15 Jyani R, Ranade D, Joshi P. Spectrum of Orbital Cellulitis on Magnetic Resonance Imaging. Cureus 2020; 12: e9663
• 16 Santos JC, Pinto S, Ferreira S. et al. Pediatric preseptal and orbital cellulitis: A 10-year experience. Int J Pediatr Otorhinolaryngol 2019; 120: 82-88
• 17 Flavahan PW, Cauchi P, Gregory ME. et al. Incidence of periorbital necrotising fasciitis in the UK population: a BOSU study. Br J Ophthalmol 2014; 98: 1177-1180
• 18 Amrith S, Hosdurga Pai V, Ling WW. Periorbital necrotizing fasciitis – a review. Acta Ophthalmol 2013; 91: 596-603
• 19 Lazzeri D, Lazzeri S, Figus M. et al. Periorbital necrotising fasciitis. Br J Ophthalmol 2010; 94: 1577-1585
• 20 Cereceda-Monteoliva N, Lewis H, Al-Himdani S. et al. Periorbital necrotising fasciitis with underlying undiagnosed hepatitis C infection. BMJ Case Rep 2019; 12: e223720
• 21 Fung V, Rajapakse Y, Longhi P. Periorbital necrotising fasciitis following cutaneous herpes zoster. J Plast Reconstr Aesthet Surg 2012; 65: 106-109
• 22 Umbert IJ, Winkelmann RK, Oliver GF. et al. Necrotizing fasciitis: a clinical, microbiologic, and histopathologic study of 14 patients. J Am Acad Dermatol 1989; 20: 774-781
• 23 Hietbrink F, Bode LG, Riddez L. et al. Triple diagnostics for early detection of ambivalent necrotizing fasciitis. World J Emerg Surg 2016; 11: 51
• 24 Wong CH, Khin LW, Heng KS. et al. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004; 32: 1535-1541
• 25 Bechar J, Sepehripour S, Hardwicke J. et al. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature. Ann R Coll Surg Engl 2017; 99: 341-346
• 26 Kwee RM, Kwee TC. Diagnostic performance of MRI and CT in diagnosing necrotizing soft tissue infection: a systematic review. Skeletal Radiol 2022; 51: 727-736
• 27 Barker FG, Leppard BJ, Seal DV. Streptococcal necrotising fasciitis: comparison between histological and clinical features. J Clin Pathol 1987; 40: 335-341
• 28 Elner VM, Demirci H, Nerad JA. et al. Periocular necrotizing fasciitis with visual loss pathogenesis and treatment. Ophthalmology 2006; 113: 2338-2345
• 29 McHenry CR, Piotrowski JJ, Petrinic D. et al. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995; 221: 558-563 discussion 563–565
• 30 Pippal SK, Kumar D, Ukawat L. Management Challenge of Rhino-Orbito-Cerebral Mucormycosis in Covid 19 Era: A Prospective Observational Study. Indian J Otolaryngol Head Neck Surg 2021; 23: 1-7
• 31 Prakash H, Chakrabarti A. Global Epidemiology of Mucormycosis. J Fungi (Basel) 2019; 5: 26
• 32 Muthu V, Rudramurthy SM, Chakrabarti A. et al. Epidemiology and Pathophysiology of COVID-19-Associated Mucormycosis: India Versus the Rest of the World. Mycopathologia 2021; 19: 1-16
• 33 Sen M, Honavar SG, Bansal R. et al. members of the Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC) Study Group. Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1. Indian J Ophthalmol 2021; 69: 1670-1692
• 34 Mehta R, Nagarkar NM, Jindal A. et al. Multidisciplinary Management of COVID-Associated Mucormycosis Syndemic in India. Indian J Surg 2021; 6: 1-9