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[Clinical evaluation of cefroxadine in bacterial infections of the eye].

Cefroxadine (CXD) capsules and dry syrup, an oral cephem antibiotic, were administered into 120 cases with ocular infections and the following results were obtained: The daily dose of CXD capsule was ranged from 500 to 1,500 mg and that of CXD dry syrup from 17.9 to 85.7 mg/kg, and the duration of CXD administration was from 2 days to 14 days. Clinical response rates classified by diagnosis The clinical response rates were 77.8% (14/18) in blepharitis, 86.7% (26/30) in hordeolum, 62.5% (5/8) in meibomianitis, 74.6% (44/59) in conjunctivitis, 100% (2/2) in corneal infiltration, 100% (1/1) in cellulitis of the lid, in dacryocystitis and in corneal ulcer, respectively. Clinical response classified by isolated organisms The response rates on S. aureus were 80.0% (20/25), on S. epidermidis 75.8% (47/62) and on S. pneumoniae 66.7% (2/3), respectively. The overall clinical response rate on Gram-positive bacteria was 78.3% (94/120). The response rates on H. influenzae, Acinetobacter spp., P. mirabilis, E. coli and Moraxella spp. were ranged from 42.9 to 100%. The sensitivity distributions of clinically isolated S. aureus and S. epidermidis to CXD were ranged from 1.56 to greater than 100 micrograms/ml and from 0.39 to 12.5 micrograms/ml, respectively. The former showed a peak at 3.13 micrograms/ml and the latter in 1.56 micrograms/ml. Side effects in 3 cases (2.3%) out of 129 were observed. That is; glossitis, thirst feeling and palpitation in each case, respectively.

Administration, Oral↗

Epidermoid carcinoma of the lacrimal sac: a clinicopathological case report.

Epidermoid carcinomas of the lacrimal sac are rare. We report a case that illustrates the difficulties in their diagnosis. When the diagnosis was made in our patient the tumour had extended beyond the sac wall and treatment was unsuccessful. The prognosis of these tumours depends on early diagnosis and complete excision, which demands a high degree of suspicion in all cases of chronic tearing, chronic dacryocystitis or a nonreducible mass in the area of the lacrimal sac. Consultation with an otolaryngologist is esential in both diagnosis and management.

Aged↗

[Eyelid and lacrimal abscesses].

Nonspecific eyelid abscesses are rare, whereas periorbital infections occur more frequently. Localisation of a maximum number of inflammatory signs is essential for diagnosis. A superior external localisation suggest dacryoadenitis or infection of a dermal cyst and the end of the eyebrow. An internal canthal localisation would reflect lacrimal disorder. In the adult, the main cause of infection is acute dacryocystitis. After antibiotic and anti-inflammatory drug treatment, dacryocystorhinotomy is necessary to preclude recurrence. In the newborn, bilateral forms of dilatation of the lacrimal sacs can lead to respiratory distress. The treatment of choice is resection of the endonasal pouches.

Abscess↗

[Orbital cellulitis in children].

BACKGROUND: Because the potential for complications is great, orbital cellulitis must be recognized promptly and treated aggressively. POPULATION AND METHODS: The files of 38 children admitted from 1988 to 1993 because of orbital or periorbital cellulitis were retrospectively analyzed. Clinical findings included fever, edema, pain, rhinorrhea, conjunctivitis, limitation of eye movement, loss of vision and ophthalmoplegia. All patients had hemogram, ionogram, blood cultures, search for soluble antigens in blood and/or urine, C-reactive protein measurement; they also had roentgenographic examination of the sinuses, orbital ultrasonography and/or CT scan in patients with retroseptal cellulitis. All patients were given systemic antibiotic therapy. RESULTS: Thirty-five patients had preseptal and three retroseptal cellulitis. Preseptal cellulitis was associated to sinusitis in 17 patients, to ocular infection in 11 (seven conjunctivitis and four dacryocystitis), to an infected wound in six. Seventy-three per cent of the patients with ocular infection were less than 2 years of age with a significant preponderance of girls (64%). The three cases of retroseptal cellulitis were associated to sinusitis. Orbital echography was performed in five cases, permitting to recognize the three cases of retroseptal cellulitis that was confirmed by CT scan. Twenty-five of the 38 children were given oral antibiotics during the days preceding admission, explaining the relative rarity of positive bacteriological findings (seven cases). Thirty-five of the 38 children were given IV cefotaxime + fosfomycin, associated to netromycin in 16 cases. Mean duration of treatment was 3 days (range: 1-7). IV antibiotherapy was followed by oral amoxicillin-clavulanic acid administration in 25 patients and pristinamycin in 11. CONCLUSIONS: Orbital cellulitis in children, more frequently preseptal, have a good prognosis under adapted antibiotherapy. A retroseptal cellulitis requires multidisciplinary management because of the risk of extension of infection from the orbit to the eye and/or into the cranial cavity.

Anti-Bacterial Agents↗

Neonatal conjunctivitis: a profile.

Neonatal conjunctivitis is one of the commonest infections encountered in the newborn. A prospective study was conducted on all babies born over a period of one year. No prophylactic ocular medication was instilled routinely in newborns. Babies developing purulent eye discharge were diagnosed to have conjunctivitis. Eye Swab from the neonates and maternal vaginal/cervical swabs were sent for culture. Chloromycetin eye drops were used for treatment and in case of no response, changed as per sensitivity report or to gentamicin eye drops. Oral erthromycin was given for dacryocystitis or when there was no response to topical therapy. The incidence of conjunctivitis was 7.2%. Two seasonal peaks, namely, February and then May and June, were noted. In 91.6% of the babies, conjunctivitis developed within the first week. A prolonged rupture of membranes was associated with a significantly higher incidence of conjunctivitis (p < 0.01). The most common organism grown from conjunctival swab was Staph aureus (35.2%) followed by Enterococcus (4.3%), Klebsiella (3.5%) and E. coli (2.8%). From vaginal/cervical swabs, E. coli was the most common organism isolated. No concurrence of organisms was noted between eye swabs and vaginal/cervical swabs. A uniformly good response to chloromycetin eye drops was noted with only 3.5% requiring a change of therapy. It is concluded that neonatal conjunctivitis is commonly acquired postnatally and responds well to topical chloromycetin therapy. Oral erythromycin may be used in resistant cases which will cover the chlamydial infection also.

Anti-Bacterial Agents↗

[Transient internal palpebral inocclusion after dacryocystorhinostomy].

The authors report two cases of postoperative lagophthalmos immediately following ab externo dacryocystorhinostomy (DCR). Two female patients, aged 67 and 62 years, underwent under general analgesia for chronic dacryocystitis with mucocele. An inferior surgical approach, sparing the inner canthal ligament was chosen in both cases.

Aged↗

[Ocular manifestations in Peters' syndrome].

The analysis of twenty-one observations with Peter Syndrome, shows that the disease was established by a disorder in the development of the mesoderm who gives birth at the posterior, stratum of cornea, iris stroma and angle of the posterior chamber. The disease was associated with cataract (nine cases), strabismus (seven cases), congenital glaucoma (five cases), microophthalmia (three cases), microcornea (four cases), remainders of the pupillary membrane (one case), vitreous opacities (one case), facial malformations (one case), congenital dacryocystitis (one case), nystagmus (four cases). The presence at the same patient of the posterior keratoconus or staphiloma of cornea at one eye and Peter syndromme at the other eye, is possible to say that these diseases are evolutionary stages by one and the same mesodermal disgenesia.

Adolescent↗

Normal anatomy and lesions of the lacrimal sac and duct: evaluated by dacryocystography, computed tomography, and MR imaging.

Diseases of the lacrimal system are optimally evaluated by dacryocystography, CT, MR imaging, and nuclear scintigraphy. Dacryocystography is selected to define the lumen of the lacrimal drainage system in inflammatory disease (dacryocystitis), dacryoceles, dacryoliths, and developmental abnormalities. Dacryocystography provides supplemental information in benign and malignant tumors, principally to differentiate an intrinsic lesion from an extrinsic lesion. CT is indicated for delineation of palpable mass lesions such as cysts, benign and malignant tumors, and diseases, especially in the paranasal sinuses, affecting the lacrimal apparatus secondarily. MR imaging has limited application but is useful to differentiate fluid from solid masses within the sac and to define tumor extension from the sac into the duct and anatomic regions outside the sac and duct. MR imaging with gadolinium enhancement should be used in suspected tumors and to separate a cyst from a solid mass. Radiologic methods fail to identify the histopathology of benign and malignant tumors. Nuclear scintigraphy is helpful in patients with epiphora with no demonstrable anatomic abnormality on dacryocystography.

Diagnosis, Differential↗

[Modern principles of endonasal surgery on the lacrimal duct].

Intranasal operations on the lacrimal duct developed in 1910 by G. West are rarely used now. The author analyzes his experience gained in 5000 endonasal dacryocystorhinostomies (96.7% of which were effective) and the advantages of intranasal approach to the lacrimal duct and presents a working classification of dacryocystitis. Indications for endonasal surgery on the lacrimal duct and contraindications precluding it are defined and a table for selecting the appropriate intranasal intervention in cases with abnormal discharge of tears offered. The author emphasizes the efficacy of endonasal operations and advocates wide use of this method in dacryology.

Adolescent↗

[Silastic implants and reconstruction of the orbital floor: review of twenty year's experience].

Fractures of the orbital floor still raise unresolved therapeutic problems concerning the operative indication or the type of material to be used during repair. For this purpose, surgeons have the choice between heterologous or autologous grafts, implants and numerous biomaterials. The authors conducted a retrospective study with a follow-up of 20 years of 137 patients treated in the department for a fracture of the orbital floor using a Silastic implant. The reoperation rate to remove the implant was 13.8%. Various complications were observed: dacryocystitis, migration of the implant to the skin and maxillary sinus, cutaneous fistula, persistent diplopia, orbito-sinus communication, periorbital cellulitis. In view of these complications, it appears preferable to modify the therapeutic approach and propose autotransplantation of the concha for defects less than 1.5 cm2 and autologous parietal bone graft for larger defects.

Adult↗