Search

Purpose: This study aimed to determine risk factors, and describe management and outcomes in patients who developed orbital cellulitis secondary to dacryocystitis., Methods: Multicenter retrospective case series with 18 patients and review of published cases., Results: The mean age was 62 years, 56% were female and 50% had recurrent dacryocystitis. Visual acuity was reduced in the affected eye with a mean of 0.27 logMAR (Snellen 20/40) which improved to 0.15 logMAR (Snellen 20/30) at final follow up. Two cases (12%) had dacryoliths and 1 patient had sarcoidosis within the lacrimal sac. Gram-positive bacteria were identified in 73% (11/15), gram-negative bacteria in 13% (2/15), and mixed infection in 13% (2/15), respectively. Cases who had dacryocystorhinostomy as definitive treatment, either acutely (n = 3) or electively (n = 10) had full resolution. Transcutaneous drainage of the medial wall abscess in 10 patients helped resolve acute cellulitis. Four patients declined dacryocystorhinostomy after transcutaneous drainage; 2 had repeated dacryocystitis and orbital cellulitis, while 2 had no further infective episodes. One immunosuppressed patient had rapid progression to non-perception-of-light vision due to fungal invasion. Forty-six published cases reported up to 28% permanent loss of vision (perception-of-light and non-perception-of-light). Dacryoliths were discovered in 17% of published cases., Conclusions: Orbital cellulitis complicating dacryocystitis appears to be related to recurrent dacryocystitis and possibly the presence of dacryoliths. Immunosuppression is identified as a poor prognostic factor in this series. While transcutaneous drainage works well as a temporizing measure, dacryocystorhinostomy either done acutely or deferred until resolution of orbital cellulitis is required for definitive cure., Competing Interests: The authors have no financial or conflicts of interest to disclose., (Copyright © 2024 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)

Merkel cell carcinoma is a rare neuroendocrine tumor of subspecialized dermal mechanoreceptors, associated with immunosuppression. The usual ophthalmic presentation is an eyelid lesion. The authors present a case of biopsy-proven orbital metastatic Merkel cell carcinoma in the absence of any eyelid lesion, in an immunosuppressed patient with a history of multiple cancers. There are to the authors' knowledge only 2 other case reports of presumed metastatic Merkel cell carcinoma to the orbit, though neither were biopsied. Despite its rarity, metastatic Merkel cell carcinoma should be included in the differential of a metastatic orbital lesion, in the patient with a known or suspected cutaneous primary. The patient has had an excellent response to combined radiotherapy and programmed death-1 inhibitor pembrolizumab, and this case highlights the potential benefit of an exciting new biologic therapy.