Cavernous Sinus Thrombosis Complication in Young Diabetic - Case Study from TOSCON 2024
Cavernous sinus thrombosis is a severe complication of rhino-orbito-cerebral mucormycosis in a young uncontrolled diabetic patient presented at the 9th Annual State Ophthalmological Conference (TOSCON) 2024. The case involves a 30-year-old male with diabetes, experiencing headache, fever, and rapid onset of eye symptoms. Prompt diagnosis, functional endoscopic sinus surgery, orbital decompression, and antifungal treatment led to significant improvement and vision restoration in the affected eye.
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Manoj Mathur E-Poster [Title of the E-Poster] [Presenting Author s Name] 9thAnnual State Ophthalmological Conference TOSCON 2024 12thto 14thJuly, 2024 at Katriya Hotel & Towers, Hyderabad CAVERNOUS SINUS THROMBOSIS AS A COMPLICATION OF RHINO ORBITO CEREBRAL MUCORMYCOSIS IN YOUNG UNCONTROLLED DIABETIC PRESENTER DR.SOMULA SOWJANYA, RESIDENT, KRISHNA INSTITUTE OF MEDICAL SCIENCES, SECUNDERABAD . MODERATOR DR .PRANATHI. B , SENIOR CONSULTANT KRISHNA INSTITUTE OF MEDICAL SCIENCES, SECUNDERABAD
9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad INTRODUCTION Cavernous sinus thrombosis is a life-threatening infection with a mortality rate of 30% to 40% caused by retrograde spread infection from the upper dentition or paranasal sinuses through the valveless ophthalmic venous system to the cavernous sinus. The development of thrombosis within the cavernous sinuses causes decreased drainage of the superior and inferior ophthalmic veins, resulting in periorbital edema, ptosis, proptosis, chemosis, ophthalmoplegia, and vision loss. A 30 year old male presented with complaints of headache and fever since 2 days followed by swelling of right eye with loss of vision and within 2 hours left eye swelling with decreased vision.He had diabetes mellitus since 2 months. His random blood sugar was 397 mg/dl.
9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad CASE REPORT Patient initial presentation with decreased vision, lid oedema, conjunctival chemosis and congestion,proptosis. Visual acuity Right eye-PL+, Visual acuity Left eye-cf@3mts, EOM restriction in both eyes. FUNCTIONAL ENDOSCOPIC SINUS SURGERY+ BILATERAL ORBITAL DECOMPRESSION DONE PATIENT HAD LID OEDEMA, CHEMOSIS,CONGESTION, PROPTOSIS FROZEN SECTION BIOPSY - MUCORMYCOSIS
9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad Patient symptoms improved gradually with TRANSCUTANEOUS RETROBULBAR AMPHOTERICIN B(5 doses) + IV AMPHOTERICIN(42 days) Patient regained vision in left eye ( 6/6) and both eyes anterior segment was normal
9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad MATERIAL AND METHODS It is important to evaluate a patient with suspected orbital cellulitis for extraocular movements,pain with eye movements,visual acuity and proptosis. Patients with orbital cellulitis in immunocompromised status with suspicion of fungal infection like mucormycosis and invasive aspergillosis have to do Blood culture and sensitivity,MRI Venography,MRI brain with orbits and paranasal sinus, CT Scan. MRI shown bilateral invasive sinusitis,bilateral orbital cellulitis,cavernous sinus thrombosis and involvement of central skull base with extension upto prepontine cistern.
9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad DISCUSSION Cavernous sinus thrombosis (CST) is a rare, life- threatening disorder. CONCLUSION Early recognition of cavernous sinus thrombosis which, often presents with fever, headache, eye findings such as periorbital swelling, and ophthalmoplegia, is critical for a good outcome. Orbital cellulitis is a serious infection the most important feature is ophthalmoplegia,pain with eye movements,proptosis . In immunocompromised patients with orbital cellulitis mucormycosis and invasive aspergillosis should be suspected as cause of orbital cellulitis. Early diagnosis and intervention can prevent life-threatening systemic complications and prevent mortality. Rhino-orbital cerebral mucormycosis is caused by fungi of the Mucorales order, most commonly by the species Rhizopus oryzae. Rhino-orbital mucormycosis usually leads to acutely fatal fungal infections in immunocompromised patients through central nervous system invasion or vascular thrombosis. Importance of multidisciplinary approach in early diagnosis and treatment to prevent mortality,improve quality of life,prevent ocular morbidity,improves visual prognosis