young male of 25 yrs age came to me with the complaints of headache, vomiting, pain , swelling, loss of vision LE from yesterday. h/o common cold, burning micturition and one episode of some blood in vomitus. o/e.LE -lid edema,proptosis, conjunctival congestion and Chemosis present AC shallow, iop increased on digital tonometry pupil slightly dilated and fixed fundal glow absent VA PL positive but PR defective Pt. Positive for HCV USG Left hydronephrosis present diagnosis and management pls

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This case is turned out to be a case of panophthalmitis, vision is PL negative so now I am dealing with a case of painful blind eye. Investigations are as follows TLC 15000, NEUTROPHILIA, DERRANGED LFT, Derranged KFT, traces of protein in urine, RBS normal. Now enlighten me with your opinions on eye saving management as my goal is shifted to preserve anatomy when I am unable to save the physiology......

It is endogenous endophthalmitis resulting in panophthalmitis. As the patient is positive for hcv and having hydronephrosis, sepsis may be present. Do blood culture, tc,dc, blood sugar, conjunctivitival swab and x-ray/CT orbit and pns. Meanwhile start on empirical treatment with broad spectrum antibiotics. If not responding, evisceration is the only option.

Orbital cellulitis with acute congestive glaucoma must chack BP put on inj purezone 1gm bd immediately and other routine medicines wit glaucoma treatment as per your plan

BP normal
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D.D : Endophthalmitis complicated by panophthalmitis . * Acute orbital cellulitis.

Sir your suspicion is correct .....I am treating the case on the lines of panophthalmitis.......
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Acute orbital cellulitis

Thanks sir
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Discharge is present... Some infectious etiology must be there, probably through sinuses... He is Hcv positive.. Check for leucocyte count.. Other viral markers like HIV, Hbsag, Hbv antibody, X-ray chest for ptb, b sugar status, Merely presence of hydronephrosis unilateral would not restrict iv antibiotics broad-spectrum unless it is bilateral or raised b urea, s creatinine, So it's orbital cellulitis turning in to panophthalmitis , could be mixed bacterial as well as mucor due to immunocompromised status.. Unfortunately above explaination is for doctors satisfaction n documentation, as vision could not be revived back. So take care of urself first by double protection .. Take written consent n plan accordingly as mentioned by other doctors above.. Bst of luck

Thanks Dr Anand
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thanks curofy
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Pulsatilla (P) 6, Staphysagria 6 (pain), calcar iodide 6 (recurrent), belladonna 30 (swelling of pain), gelsimium 30, causticum 6 (eyes not open)

Iop for the eye is responsible. Rest kidney profile should be taken care of. Rule out yhe glucoma too.

Give broad spectrum antibiotics. IV mannitol blood culture should be done.

Mam pt kidney is compromised, how to give mannitol
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