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Abstract
Purpose
To investigate the effects of additional prednisolone treatments in orbital cellulitis after bougination.
Methods
The medical records of five patients treated for orbital cellulitis after bougination were reviewed. The number of times bouginated, clinical symptoms, biopsy findings, treatment course, recurrence, and prognosis were reviewed.
Results
A diffuse, erythematous mass on the lower lid around the medial canthal area was found in all patients. Bougination was performed more than twice in three patients. Chronic inflammation was checked via pathologic tissue biopsy examination in four patients. No patients receiving antibiotic treatments improved, thus additional prednisolone was used and showed satisfactory results, although recurrence was observed in two patients. The recurred two patients improved with repetitive prednisolone treatments.
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Figure 1.
(A) Photograph of a 54-year-old woman with marked diffuse and erythematous lid swelling of the left eye on admission (case 1). (B) Photograph of a 66-year-old woman with marked diffuse and erythematous lid swelling with a pustule of the right eye on admission (case 2). All Orbital CT scans show a diffuse inferomedial orbital inflammation or mass.
Figure 2.
(A, B) Neutrophils and lymphocytes are increased and stromal fibrosis are founded (hematoxylin-eosin) (case 4), A (×40), B (×200). (C, D) Lymphocytes and spindle cells of fibroblastic/myofibroblastic appearance permeate the adipose tissue (hematoxylin-eosin) (case 5), C (×40), D (×200).
Figure 3.
(A) Photograph of a 54-year-old woman with marked diffuse and erythematous lid swelling of the left eye despite additional antibiotics therapy (case 1). (B) Photograph of a 66-year-old woman with marked diffuse and erythematous lid swelling with pustule of the right eye despite additional antibiotics therapy (case 2).
Figure 4.
(A) Photograph of a 54-year-old woman with improvement of marked diffuse and erythematous lid swelling of the left eye after additional steroid therapy (case 1). (B) Photograph of a 66-year-old woman with improvement of marked diffuse and erythematous lid swelling with pustule of the right eye after additional steroid therapy and surgical drainage (case 2).
Table 1.
Demography
| Case | Sex/Age | Initial symptoms | Eye | Follow-up periods (mon) | The number of times being bouginated |
|---|---|---|---|---|---|
| 1 | F/54 | Cheek swelling, Redness, LOM* (inf gaze, mild) | OS | 7 | 1 |
| 2 | F/66 | Lower lid swelling, Redness, tenderness | OD | 5 | ≥2 |
| 3 | F/64 | Cheek swelling, redness, tenderness | OS | 11 | 1 |
| 4 | F/36 | Palpable lower lid mass | OD | 3 | ≥2 |
| 5 | F/60 | Lower lid swelling | OS | 7 | ≥2 |
Table 2.
Results of additional prednisolones treatment
| Case | Initial antibiotics (first + second, wk) | Additional prednisolones (wk) | Recurrence |
|---|---|---|---|
| 1 | (3 + 2)* | 12 | Recurred (using steroids for 2 weeks |
| → Recurred again after tapering | |||
| → improved after using steroids for 6 weeks) | |||
| 2 | (12 + 1)* | 4 | Improved |
| 3 | (3 + 2)* | 2 | Improved |
| 4 | (7 + 1)* | 9 | Improved |
| 5 | (7 + 2)* | 8 | Recurred (improved after using steroids for 2 weeks) |
| Average (mean ± SD, wk) | 8.00 ± 3.32 | 7.00 ± 4.00 |
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