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Show Letters to the Editor Conservative Treatment for Penetrating Injuries Involving the Cavernous Sinus: Response W e thank Drs. Nguyen et al for their interest in our recent report (1). Consideration of steroid therapy is interesting, with net benefit often being unclear. It is our practice to consider steroids when processes with an inflammatory component threaten vital structures, such as the optic nerve. In the setting of infection, avoiding steroids is preferable if the infectious organism or its sensitivity remains unknown. We are more apt to recommend steroid therapy if able to implement concurrently with effective antibiotic therapy. In our patient with an embedded fish jaw fragment, there was significant potential for infection from any number of organisms. Because of this and duration since the injury, anti-inflammatory measures were not Letters to the Editor: J Neuro-Ophthalmol 2018; 38: 419-425 pursued. We are pleased that Dr. Nguyen's patient with a longhorn cattle injury fended well. We agree that at times, "less is more." Timothy J. McCulley, MD Clarissa Kum, DO Jessica R. Chang, MD Anna M. Gruener, MD The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland The authors report no conflicts of interest. REFERENCE 1. Kum C, Chang JR, Gruener AM, McCulley TJ. Nonsurgical management of retained needlefish jaw. J Neuroophthalmol. 2018;38:190-191. 425 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |