title: Periocular and anterior orbital necrosis after upper eyelid gold weight loading: operation-related or self-inflicted?
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.
authors.affiliation: Oculoplastic and Orbital Institute, Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Schwartz
authors.affiliation: Oculoplastic and Orbital Institute, Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Ben Cnaan
authors.affiliation: Department of Plastic Surgery, Assaf Harofeh Medical Center, Tzrifin, Israel.
authors.forename: Ophir
authors.initials: O
authors.lastname: Schein
authors.affiliation: Infectious Disease Unit, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Giladi
authors.affiliation: Pathology Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Raz
authors.affiliation: Oculoplastic and Orbital Institute, Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Igal
authors.initials: I
authors.lastname: Leibovitch
keywords: evisceration; factitious disorder; lagophthalmos