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Periocular and anterior orbital necrosis after upper eyelid gold weight loading: operation-related or self-inflicted?

Authors Schwartz R, Ben Cnaan R, Schein O, Giladi M, Raz M, Leibovitch I

Received 16 December 2013

Accepted for publication 21 January 2014

Published 30 April 2014 Volume 2014:8 Pages 843—846


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Roy Schwartz,1 Ran Ben Cnaan,1 Ophir Schein,2 Michael Giladi,3 Michal Raz,4 Igal Leibovitch1

1Oculoplastic and Orbital Institute, Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 2Department of Plastic Surgery, Assaf Harofeh Medical Center, Tzrifin, Israel; 3Infectious Disease Unit, 4Pathology Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Abstract: A 44-year-old woman, who had undergone gold-weight implantation due to facial palsy and lagophthalmos, arrived at the ophthalmology ward with eyelid swelling and erythema, which rapidly deteriorated under intravenous antibiotics to a necrotic process involving the periocular tissues, the eye, and the anterior orbit. Despite prompt removal of the gold weight, the patient's ocular and systemic condition continued to deteriorate, necessitating evisceration and debridement of necrotic tissue. Cultures showed growth of Staphylococcus epidermidis, Staphylococcus capitis, Candida glabrata, and Candida albicans, and histopathology demonstrated an acute nonspecific necrotizing panophthalmitis. Later on, the patient was admitted to a plastic surgery ward with recurrent severe burns of her thigh, which were highly suggestive of being self-induced, raising the possibility of self-induced damage.

Keywords: evisceration, factitious disorder, lagophthalmos

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