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Show Letters to the Editor Mark Morrow, MD Department of Neurology, Harbor-UCLA Medical Center, Torrance, California The author reports no conflicts of interest. REFERENCES 1. Morrow MJ, Ko MW. Should oral corticosteroids be used to treat demyelinating optic neuritis? J Neuroophthalmol. 2017;37:444-450. Conservative Treatment for Penetrating Injuries Involving the Cavernous Sinus A n interesting case recently was published of a traumatic needlefish jaw puncture wound that penetrated the medial orbit and entered the cavernous sinus (1). The patient underwent foreign body removal and was administered systemic antibiotics. No further treatment or medication was provided and the patient recovered from his injury. We present a similar case of a penetrating injury of the cavernous sinus that resolved completely with conservative management. A 74-year-old man sustained injury after a longhorn hit him directly in the left eyelid with the horn positioned parallel to the plane of the eye. Examination of the left eye revealed complete ptosis, moderate periorbital ecchymosis and edema, and total ophthalmoplegia. There was a 1-cm laceration of the nasal upper eyelid with fat prolapse. Visual acuity, intraocular pressure, pupillary reactions, and fundus examination were normal with no evidence of injury to the globe. Exploration of the eyelid laceration revealed no foreign body. The wound was irrigated with bacitracin solution and the laceration was repaired. The patient was admitted for 24-hour observation with intravenous antibiotics. Steroids were not prescribed and the patient had complete resolution at 4month follow-up. Although standard treatment guidelines currently do not exist for this rare type of injury (2), steroids are widely used due to their anti-inflammatory effects (3). Surgical intervention is considered when symptoms and signs are refractory to steroids or in the presence of an obvious hematoma, foreign body, or bony compression. Conservative manage- 424 2. Morrow SA, McEwan L, Alikhani K, Hyson C, Kremenchutsky M. MS patients report excellent compliance with oral prednisone for acute relapses. Can J Neurol Sci. 2012;39:352-354. 3. Le Page E, Veillard D, Laplaud DA, Hamonic S, Wardi R, Lebrun C, Zagnoli F, Wiertlewski S, Deburghgraeve V, Coustans M, Edan G; COPOUSEP Investigators, West Network for Excellence in Neuroscience. Oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (COPOUSEP): a randomized, controlled, double-blind, non-inferiority trial. Lancet. 2015;386:974-981. ment has been implicated in cases of trauma, resulting in complete or partial resolution (4). Our patient and the patient reported by Kum et al (1) support, in select patients, the practice of observation alone for treatment of cavernous sinus syndrome, avoiding potential risks associated with steroid use and surgical intervention. Kimberly Nguyen, BS University of Texas Health Science Center at Houston Medical School, Houston, Texas Ama Sadaka, MD Amina Malik, MD Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas The authors report no conflicts of interest. REFERENCES 1. Kum C, Chang JR, Gruener AM, McCulley TJ. Nonsurgical management of retained needlefish jaw. J Neuroophthalmol. 2018;38:190-191. 2. Chen C, Wang T, Tsay P, Huang F, Lai J, Chen Y. Traumatic superior orbital fissure syndrome: assessment of cranial nerve recovery in 33 cases. Plast Reconstr Surg. 2010;126:205-212. 3. Rai S, Rattan V. Traumatic superior orbital fissure syndrome: review of literature and report of three cases. Natl J Maxillofac Surg. 2012;3:222-225. 4. Fujiwara T, Matsuda K, Kubo T, Tomita K, Yano K, Hosokawa K. Superior orbital fissure syndrome after repair of maxillary and naso-orbito-ethmoid fractures: a case study. J Plat Reconstr Aesthet Surg. 2008;62:e565-e569. Letters to the Editor: J Neuro-Ophthalmol 2018; 38: 419-425 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |
