Orbital mycosis
Introduction
Introduction to orbital mycosis The incidence of orbital fungal diseases is extremely low. Common pathogenic bacteria include mucor, aspergillus and cryptococcus, as well as actinomycetes and penicillium. When the fungus is parasitic in the normal tissues of the human body, such as the sinus and conjunctival sac. Generally, it does not cause disease. When the body's immunity is reduced, trauma, large doses of corticosteroids or broad-spectrum antibiotics are widely used, parasitic fungi can cause disease. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: eyelid abscess
Cause
Causes of orbital fungal diseases
Infection (30%):
Mucormycosis is caused by Mucor, Pulmonium or Rhizopus, and is classified as a sub-class of bacteria. It is commonly found in soil, air and moldy food. It can be cultured in any opening of the throat, nose and body. This fungus, which does not cause disease under normal conditions, is a non-pathogenic opportunistic pathogen. Most patients have diabetes and poor control with ketoacidosis.
Impaired immune function (30%):
Can also occur in high-dose antibiotics, corticosteroids, ionizing radiation and antimetabolites to treat patients with impaired immune function; multiple myeloma, cancer, congenital heart disease, severe gastritis, hepatitis and cirrhosis, extensive burns Weak patients are also susceptible to mucormycosis, but very few healthy people are infected with mucormycosis. It is estimated that these patients have potential systemic diseases. In many cases, infections originate from the sputum, nose and sinus, especially the ethmoid sinus. The sphenoid sinus then directly invades the eyelids.
Pathology (25%):
Fungi can invade blood vessels and cause thrombosis, which aggravates inflammation and tissue necrosis. At the same time, a large number of polymorphonuclear leukocytes infiltrate, and granulomatous reactions can be seen around the necrotic tissue. The surgically removed lesions can be stained with hematoxylin eosin. The mycelium has an affinity for hematoxylin, and the PAS staining shows that the hyphae is 30 to 50 m wide and has no branching.
Prevention
Orbital fungal disease prevention
For patients with diabetes who are difficult to control, long-term use of glucocorticoids and patients with low immune function requires close attention to the occurrence of fungal infections.
Complication
Orbital fungal disease complications Complications, eyelid abscess
Mixed bacterial infection forms a spasm abscess and the like.
Symptom
Symptoms of orbital fungal disease Common symptoms Nasal bleeding Visual impairment Congestive eyeballs Can not be arbitrarily painful and painful Cellulitis Optic nerve atrophy Retinal edema Scars Eye muscle paralysis
The lesion is located in the anterior part of the iliac crest. Early stage can be manifested as orbital cellulitis or embolic phlebitis, eyelid and cheek pain, runny or nosebleed, swollen eyelids, congestion, hard mass in the palate, tenderness, If the lesion is deep or the anterior lesion is deeper, the eyeball is gradually aggravated, the eyeball is up or out, and the eye movement is limited. When the lesion invades the apex, the apex syndrome may occur, that is, the vision is decreased. The axial part of the eye is prominent, the muscles inside and outside the eye are paralyzed, the upper eyelids are drooping, the facial pain is painful, the fundus examination shows optic disc edema, the posterior pole retinal edema, the retinal vein dilatation, the optic nerve atrophy, and the mucor infection can be seen in the nasal cavity with necrotic scarring.
Examine
Eyelid fungal disease examination
Diseased tissue biopsy is important and fungal hyphae can be found.
X-ray inspection
It shows that the density of the sinus is increased, the humerus is destroyed, and the density of soft tissue in the sac is not easy to find.
2. Ultrasound exploration
A-type ultrasound showed high wave after the eye wall, no waveform in the lesion, lack of posterior boundary wave, B-type ultrasound see irregular shape occupying lesions in the iliac crest, the internal echo is different, the distribution is uneven, the sound attenuation is significant, after The boundary is unclear, the pressure is not deformed, the vitreous opacity is seen when the eyeball is affected, the echogenic spots of the strong and weak are seen in the vitreous, and the wall of the eyeball is deformed by pressure.
3.CT scan
It shows irregular and high-density block shadows in the sputum, the boundary is unclear, the internal density is not uniform, the extraocular muscles and optic nerve are covered by the lumps, which are difficult to recognize. When the fascia is involved, the lesion and the eyeball are cast and the eyeballs are prominent. In the late humeral wall destruction, the high-density shadow in the sinus and the lesion in the sinus were continuous, and the supracondylar fissure was enlarged. The lesion spread along the supraorbital fissure to the cavernous sinus, and the lesion invaded the intracranial.
Diagnosis
Diagnosis and diagnosis of orbital mycosis
diagnosis
According to the clinical symptoms and the manifestations of gingivitis syndrome, combined with the results of imaging examination, the diagnosis is not difficult.
Differential diagnosis
Orbital fungal infection needs to be differentiated from adult orbital cellulitis, intraorbital abscess, clinical manifestations of early or acute infection, X-ray also shows increased sinus density, the latter has little bone destruction, and ultrasound shows obvious inflammatory edema in the iliac crest. There is a T-type sign, this point has a discriminating significance, CT shows that the extraocular muscles and optic nerve are thickened but not obscured by soft tissue shadows, and the sinus is a liquid plane instead of a solid mass.
Orbital malignant lesions such as midline lethal granuloma (lethal midline granuloma) for the unexplained middle facial structure necrotic lesions, often invading the nose, oropharynx, sinus, eyelids, often involving both eyes, imaging examination and fungal infection are not easy to identify, need After histological diagnosis, the intracranial spread of sinus malignant tumors rarely shows acute inflammation, which may be accompanied by eyeball protrusion. The medial aspect of the sac can be touched with hard mass, tenderness, eye movement disorder, decreased vision, etc. The image shows sinus mass and sputum. Internal communication, extensive bone destruction, and difficulty in identifying fungal infections.
