Sultan Harris, Malik Amina, Li Helen K, Chévez-Barrios Patricia, Lee Andrew G
*Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, †Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, ‡Community Retina Group, Houston, Texas; §Departments of Ophthalmology and Pathology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; ‖Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, New York, New York, ¶Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, #Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa; **The University of Texas MD Anderson Cancer Center, Houston, Texas; ††Department of Pathology, Genomic Medicine and Ophthalmology, Houston Methodist Hospital, Houston, Texas; ‡‡Department of Pathology and Laboratory Medicine and Ophthalmology, Weil Cornell Medical School, New York, New York; and §§Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
Ophthalmic Plast Reconstr Surg. 2017 May/Jun;33(3):e75-e76. doi: 10.1097/IOP.0000000000000770.
A 50 year-old man on immunosuppressive agents presented with left eye vision loss, periorbital swelling, pain, and ophthalmoplegia. The patient was clinically found to have a central retinal artery and vein occlusion. A CT scan was performed which demonstrated intraorbital fat stranding, however the patient lacked sinus disease. The etiology of the orbital infection was held in question. The area was debrided in the operating room, and the specimen demonstrated group A streptococcal species consistent with necrotizing fasciitis. Periorbital necrotizing fasciitis should be suspected in patients with rapidly progressive orbital symptoms without sinus disease as lack of surgical intervention can result in poor outcomes. The unusual aspect to this case is the mechanism of vision loss, as the authors hypothesize that there was vascular infiltration of the infection resulting in the central retinal artery occlusion and central retinal vein occlusion which have not been previously reported secondary to necrotizing fasciitis of the orbit.
一名正在服用免疫抑制剂的50岁男性出现左眼视力丧失、眶周肿胀、疼痛和眼肌麻痹。临床检查发现该患者患有视网膜中央动脉和静脉阻塞。进行了CT扫描，显示眶内脂肪条索状影，但患者无鼻窦疾病。眼眶感染的病因存疑。在手术室对该区域进行了清创，标本显示为A组链球菌，符合坏死性筋膜炎。对于出现快速进展的眼眶症状且无鼻窦疾病的患者，应怀疑眶周坏死性筋膜炎，因为缺乏手术干预可能导致不良后果。该病例不同寻常之处在于视力丧失的机制，作者推测感染的血管浸润导致了视网膜中央动脉阻塞和视网膜中央静脉阻塞，而此前尚未有因眼眶坏死性筋膜炎继发此类情况的报道。
