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Ophthalmic Plast Reconstr Surg 2018 Oct 9. Epub 2018 Oct 9.

Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.

Purpose: To describe risk factors, clinical parameters, treatment, and prognosis for patients with septic cavernous sinus thrombosis presenting with orbital cellulitis.

Methods: Retrospective case series of 6 patients identified with septic cavernous sinus thrombosis and orbital cellulitis confirmed by magnetic resonance imaging at a tertiary care center from January 1980 to December 2016. Medical records were reviewed for demographics, risk factors, symptoms, etiology, radiographic diagnosis, complications, treatments, and outcomes. Read More

Ocul Oncol Pathol 2018 Sep 26;4(2):130-133. Epub 2017 Sep 26.

Save Sight Institute, Sydney, NSW, Australia.

We describe a case of choroidal melanoma initially presenting with orbital cellulitis, fulminant conjunctival swelling, and secondary angle closure. Despite treatment with intravenous antibiotics, the patient's condition did not improve. With further investigations including ultrasound scan and magnetic resonance imaging, a high-density lesion was found within the globe. Read More

HNO 2018 Oct 12. Epub 2018 Oct 12.

Medizinische Fakultät Martin-Luther-Universität Halle-Wittenberg, Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.

A disease or symptom of disease spreading from the vicinity of the orbit to the internal structures of the orbit is referred to as an orbital complication. Orbital complications can have a traumatic, inflammatory, allergic, or autoimmunologic cause. They are more frequent in children than adults. Read More

Am J Rhinol Allergy 2018 Oct 11:1945892418804911. Epub 2018 Oct 11.

1 Department of Ophthalmology and Otolaryngology - Head & Neck Surgery, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.

Background Osteomas are rare benign and slow-growing osteogenic tumors mainly involving frontal and ethmoid sinuses. Objectives The primary objective of our study is to present the management of cases of giant frontal sinus osteomas. Secondarily, we describe our modified unilateral osteoplastic flap approach without obliteration to remove these osteomas. Read More

J Emerg Med 2018 Sep 22. Epub 2018 Sep 22.

Children's Emergency, KK Women's and Children's Hospital, Singapore.

Background: Orbital cellulitis is an uncommon ophthalmological emergency in children, but rapid emergency department (ED) diagnosis is essential.

Case Report: A 13-year-old boy presented to our pediatric ED with left orbital cellulitis secondary to pansinusitis. Emergency bedside ocular ultrasonography was used to evaluate and expedite his management. Read More

J AAPOS 2018 Sep 18. Epub 2018 Sep 18.

Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York. Electronic address:

Detection of wooden foreign bodies within the orbit can be difficult on imaging, including computed tomography (CT). When visible, wood appears iso- or hypodense and can mimic air or fat. We report the case of a 3-year-old boy with progressive orbital cellulitis following a penetrating wood injury to the right lower lid. Read More

J Glaucoma 2018 Sep 18. Epub 2018 Sep 18.

University of Toronto Department of Ophthalmology and Vision Sciences.

Purpose: Orbital cellulitis is a rare complication of aqueous tube shunt surgery. Nine cases have been described in the literature, though the microbiologic etiology is rarely reported. Management with intravenous antibiotics and/or explantation has been described. Read More

BMJ Case Rep 2018 Sep 15;2018. Epub 2018 Sep 15.

Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, New Delhi, India.

We present two cases of culture-proven fungal keratitis on natamycin treatment which developed periocular erythema, oedema, burning sensation and pruritus within 48 hours of the addition of topical voriconazole. On clinical examination, periocular erythema with induration was noted. A diagnosis of orbital cellulitis was suspected, but the absence of pain and tenderness refuted the diagnosis on clinical grounds. Read More

J Small Anim Pract 2018 Sep 12. Epub 2018 Sep 12.

Ophthalmic Department, Dick White Referrals, Six Mile Bottom, CB8 0UH, Cambridgeshire, UK.

Objective: To describe concurrent ophthalmic diseases in dogs with retrobulbar cellulitis and abscessation.

Materials And Methods: Retrospective analysis of clinical records of dogs with retrobulbar inflammation.

Results: Forty-one dogs were diagnosed with retrobulbar inflammation; of these, 23 presented with abscessation and two with zygomatic sialoadenitis. Read More

Ophthalmic Plast Reconstr Surg 2018 Sep/Oct;34(5):e160-e162

Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, U.S.A.

A 69-year-old woman with orbital cellulitis secondary to odontogenic Streptococcus constellatus was transferred to the authors' institution for surgical management of infection refractory to intravenous antibiotics. She underwent debridement with preservation of the globe, recovering full motility. Visual recovery was limited by optic nerve ischemia. Read More

World J Emerg Med 2018 ;9(4):272-275

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India.

Background: The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the first point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies.

Methods: A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids. Read More

J AAPOS 2018 Aug 29. Epub 2018 Aug 29.

Yale Eye Center, Yale New Haven Hospital, New Haven, Connecticut. Electronic address:

We report the case of a 76-year-old man who presented with left eye pain, eyelid swelling, and restricted extraocular motility 3 days after strabismus surgery. Computed tomography of the orbits did not show drainable abscesses, but magnetic resonance imaging on postoperative day 9 showed choroidal detachment with retrobulbar abscess and dural enhancement despite broad-spectrum intravenous antibiotic use. Following incision and drainage of the abscess, which grew methicillin-resistant Staphylococcus aureus, the patient showed improvement in visual acuity, pain, and extraocular motility. Read More

J Pediatr Ophthalmol Strabismus 2018 Aug 29:1-6. Epub 2018 Aug 29.

Purpose: To describe the natural radiographic course of subperiosteal orbital abscesses that were managed medically in pediatric patients.

Methods: A retrospective case review was undertaken at Children's Mercy Hospitals and Clinics of Kansas City, Missouri. All patients admitted to the hospital and diagnosed as having orbital cellulitis or subperiosteal abscess from 2008 to 2017 were included in the study. Read More

Int J Surg Case Rep 2018 9;50:130-134. Epub 2018 Aug 9.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Introduction: Acute dacryocystitis usually presents as a pre-septal cellulitis since the lacrimal sac lies anterior to the orbital septum. Orbital cellulitis secondary to acute dacryocystitis is very rare due to a variety of anatomic barriers to the orbit but can occur and result in abscess formation with risk of visual compromise.

Presentation Of Case: We describe a case of otherwise healthy adult who presented with complete visual loss following orbital cellulitis and abscess formation secondary to acute dacryocystitis. Read More

Prim Care 2018 Sep;45(3):433-454

Department of Family Medicine, Tidelands Health MUSC Family Medicine Residency Program, 4320 Holmestown Road, Myrtle Beach, SC 29588, USA.

The primary care provider will commonly see skin and soft tissue infections in the outpatient setting. Skin and soft tissue infections range from the uncomplicated impetigo to the potentially lethal necrotizing fasciitis. This article reviews these infections based on their underlying etiology: bacterial, fungal, and viral causes. Read More

PLoS One 2018 16;13(8):e0202233. Epub 2018 Aug 16.

Department of Diagnostic and Biomedical Sciences, School of Dentistry, University of Texas Health Science Center, Houston, Texas, United States of America.

The mitis group, a member of the genetically diverse viridans group streptococci, predominately colonizes the human oropharynx. This group has been shown to cause a wide range of infectious complications in humans, including bacteremia in patients with neutropenia, orbital cellulitis and infective endocarditis. Hydrogen peroxide (H2O2) has been identified as a virulence factor produced by this group of streptococci. Read More

Lupus 2018 Oct 9;27(12):1985-1988. Epub 2018 Aug 9.

2 Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.

Systemic autoimmune diseases are associated with ocular inflammatory conditions such as episcleritis, scleritis, keratitis, and uveitis. However, ocular manifestations have been reported to correlate with the extent of systemic disease. We present a patient with scleritis, keratitis, and orbital cellulitis, as the isolated manifestation of systemic lupus erythematosus (SLE). Read More

J Coll Physicians Surg Pak 2018 Aug;28(8):654-655

Department of Paediatrics, Torbay Hospital, Torquay, UK.

Am J Ophthalmol Case Rep 2018 Sep 21;11:6-9. Epub 2018 Apr 21.

Department of Ophthalmology, University of Virginia, 1300 Jefferson Park Ave, Charlottesville, VA, 22908, USA.

Purpose: Upper eyelid ptosis has different etiologies in children and adults. In children, the common causes include orbital cellulitis, congenital ptosis, Cranial Nerve (CN) III palsy, and Horner's syndrome. The purpose of this report is to discuss an unusual presentation of ptosis. Read More

Orbit 2018 Jul 24:1-7. Epub 2018 Jul 24.

b Department of Ophthalmology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.

Purpose: To present nine new cases of superior ophthalmic vein thrombosis (SOVT) and compare these with the literature, and to assess the impact of SOVT for the clinician.

Methods: Using the data bases of the Department of Ophthalmology of the AMC, we searched for patients with radiologically evidenced SOVT between January 2006 and December 2014. In addition, a PubMed search, using the mesh term 'superior ophthalmic vein thrombosis', was done. Read More

Ned Tijdschr Geneeskd 2018 Jul 13;162. Epub 2018 Jul 13.

Franciscus Gasthuis en Vlietland, afd. Kindergeneeskunde, Rotterdam.

Newborn twins both had a blue, smooth tumour in the inner angle of the orbit; one of them had two such tumours. They were diagnosed with congenital dacryocystoceles. If decompression into the nose is not effective, patients should undergo probing early in life to reduce the incidence of dacryocystitis and orbital cellulitis. Read More

Case Rep Ophthalmol 2018 May-Aug;9(2):315-321. Epub 2018 Jun 13.

Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Background: Ocular basidiobolomycosis is an unusual infection caused by fungus of the order Entomophthorales. This fungus has been previously reported as a common cause of skin, subcutaneous, and gastrointestinal tract infection. The fungus isolation and its typical characteristics are clues for diagnosis of this uncommon pathogen. Read More

Eur Arch Otorhinolaryngol 2018 Sep 11;275(9):2387-2395. Epub 2018 Jul 11.

Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.

Purpose: Septic cavernous sinus thrombosis (CST) is a rare complication of infections in the head and neck area. CST is notorious for its bad prognosis, with high mortality and morbidity rates described in literature. However, these rates are based on old series. Read More

Ophthalmic Plast Reconstr Surg 2018 Jul/Aug;34(4):329-332

Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington.

Purpose: Axial displacement of the globe with tenting centered on the optic nerve-globe junction is a predictor of visual loss in adults. The purpose of this study was to determine the visual outcomes of children with orbital cellulitis and globe tenting.

Methods: The records of 46 consecutive children with orbital cellulitis at a single tertiary children's hospital were reviewed retrospectively. Read More

Clin Ophthalmol 2018 26;12:1149-1153. Epub 2018 Jun 26.

Department of Ophthalmology, Osaka Medical College, Takatsuki, Osaka, Japan,

Purpose: Idiopathic orbital inflammation (IOI) and orbital cellulitis can present similar clinical features, and the diagnoses of these two disorders are sometimes confused. The purpose of the present study was to determine whether or not inflammatory markers in the blood can be useful to differentiate between IOI and orbital cellulitis in cases with acute eyelid erythema and edema.

Subjects And Methods: In this retrospective single-institute study, we reviewed the medical records spanning the past 10 years at the Department of Ophthalmology, Osaka Medical College Hospital, Takatsuki, Osaka, Japan, and found 45 cases, with patients >15 years of age, with presumed IOI. Read More

Arch Dis Child Educ Pract Ed 2018 Jun 22. Epub 2018 Jun 22.

The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.

'It is midnight and you are called to see a thirteen-year-old boy who has been brought to the paediatric emergency department with a 24-hour history of swelling and redness of his left eye. He has had a 'runny nose' for a couple of days. He is systemically well. Read More

Acta Paediatr 2018 Nov 10;107(11):2028-2029. Epub 2018 Jul 10.

Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach, Tikva.

SAGE Open Med Case Rep 2018 31;6:2050313X18778726. Epub 2018 May 31.

Department of ENT-Head and Neck Surgery, KRL Hospital, Islamabad, Pakistan.

Nasal septal abscess is a rather unusual condition encountered in the Otorhinolaryngology outpatient department, let alone it being a complication of orbital cellulitis! The condition usually occurs due to trauma which is significant enough to cause a septal haematoma. The haematoma then eventually results in formation of a localised abscess. Orbital cellulitis as a sequela of nasal septal abscess is an established complication but vice versa, septal abscess as a sequela of orbital cellulitis is an extremely rare presentation. Read More

Iran J Otorhinolaryngol 2018 May;30(98):181-184

Department of Otorhinolaryngology and Head and Neck Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi-110002, India.

Introduction: Complication of an odontogenic infection to an orbital abscess is not a common presentation. The progression from a simple toothache to a condition that may lead to loss of vision is sudden and severe.

Case Report: We report a rare case in which a patient developed facial cellulitis that progressed to orbital abscess after unsterile dental manipulation by a medical fraudster ("quack"). Read More

J Craniofac Surg 2018 Jun;29(4):1020-1022

Division of Plastic and Reconstructive Surgery, Montreal Children's Hospital, McGill University, Montreal.

The authors present a rare case of nontraumatic medial orbital wall fracture in an 11-year-old girl. Fractures of the orbital wall secondary to nose blowing have not been previously described in the pediatric population. The patient reported a history of chronic forceful nose blowing, followed by periorbital swelling after an episode of vigorous nose blowing. Read More

Int J Pediatr Otorhinolaryngol 2018 Jul 8;110:123-129. Epub 2018 May 8.

Department of Otolaryngology, Boston University School of Medicine, 4th Floor, FGH Building, 820 Harrison Ave., Boston, MA 02118, United States. Electronic address:

Objectives: Orbital complications account for 74-85% of all complications from acute sinusitis, more often affect the pediatric population, and can result in devastating consequences. Therefore these patients require prompt diagnosis and proper management. We review and summarize the current literature to determine the appropriate management of each stage of pediatric orbital cellulitis and offer a new comprehensive literature-based algorithm. Read More

Clin Pract Cases Emerg Med 2018 May 14;2(2):121-124. Epub 2018 Mar 14.

University of Alabama School of Medicine, Department of Emergency Medicine, Birmingham, Alabama.

Trigeminal trophic syndrome is a rare condition that develops from trigeminal nerve damage causing dysesthesias that result in self-mutilation. Facial and nasal destruction develops from self-destructive behavior (repetitive picking or scratching) secondary to the altered skin sensation created by the damaged trigeminal nerve. Early recognition of this condition is crucial to the prevention of the detrimental complications of facial ulceration and nasal tissue necrosis that can lead to corneal ulcerations, full-thickness eyelid defect, and canthal lesions. Read More

Indian J Ophthalmol 2018 06;66(6):856-858

Department of Ophthalmology, JNMC, Belagavi, Karnataka, India.

Congenital lamellar ichthyosis is an autosomal recessive, heterogeneous disorder presenting at birth with generalized skin involvement. The most common ophthalmic manifestation noted is bilateral ectropion of the lower eyelids. A 1-month-old female neonate, the second born of a nonconsanguineous marriage, presented with 4 days' history of redness, discharge, and swelling in the right eye. Read More

Am J Ophthalmol Case Rep 2018 Jun 5;10:276-278. Epub 2018 Apr 5.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL, USA.

Purpose: To describe a case of Multi-drug resistant scleral buckle infection.

Observations: A 56 year-old male with history of retinal detachment repair with scleral buckle 20 years prior presented with 8 months of intermittent pain and redness in the left eye. The patient was diagnosed with scleral buckle infection, the buckle was removed, and cultures revealed multi-drug resistant The postoperative course included orbital cellulitis treated with systemic linezolid, clarithromycin, and imipenem. Read More

Pediatr Emerg Care 2018 May 15. Epub 2018 May 15.

Ophthalmology.

An 8-year-old male presented to the pediatric emergency department with subjective fever, blurry vision, and left eye pain. On physical examination, there was mild left lower lid erythema and a subtle left eye elevation deficit. Computed tomography demonstrated preseptal soft tissue swelling without orbital involvement; however, there was varying amounts of paranasal sinus opacification. Read More

Saudi J Ophthalmol 2018 Jan-Mar;32(1):52-55. Epub 2018 Feb 16.

Department of Ophthalmology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.

Langerhans cell histiocytosis (LCH) is a rare multi-system disease. It presents infrequently as a childhood orbital tumor, and can mimic more common inflammatory orbital disease processes. We report the clinical, histopathological, and electron microscopic findings of orbital LCH in an 18-month-old child, along with a review of the recent literature regarding molecular pathogenetic analysis of LCH. Read More

Medicine (Baltimore) 2018 May;97(19):e0706

Department of Radiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.

Rationale: Wooden transorbital penetrating injury is an uncommon and serious trauma that may cause multiply complications.

Patient Concerns: Here we describe a 62-year-old Chinese woman with a transorbital penetrating injury caused by a long bamboo branch.

Diagnosis: Computed tomography scan and magnetic resonance imaging showed the presence of a wooden foreign body. Read More

J Am Coll Radiol 2018 May;15(5S):S116-S131

Specialty Chair, UC San Diego Health, San Diego, California.

Visual loss can be the result of an abnormality anywhere along the visual pathway including the globe, optic nerve, optic chiasm, optic tract, thalamus, optic radiations or primary visual cortex. Appropriate imaging analysis of visual loss is facilitated by a compartmental approach that establishes a differential diagnosis on the basis of suspected lesion location and specific clinical features. CT and MRI are the primary imaging modalities used to evaluate patients with visual loss and are often complementary in evaluating these patients. Read More

J Ophthalmic Vis Res 2018 Apr-Jun;13(2):175-182

Orbital Service, Moorfields Eye Hospital, London EC1V 2PD, UK.

Infections of the orbit and periorbita are relatively frequent, and can cause significant local and systemic morbidity. Loss of vision occurs in more than 10% of patients, and systemic sequelae can include meningitis, intracranial abscess, and death. Numerous organisms infect the orbit, but the most common are bacteria. Read More

J Mycol Med 2018 Jun 27;28(2):384-386. Epub 2018 Apr 27.

Laboratory of parasitology mycology, Habib-Bourguiba Hospital, 3029 Sfax, Tunisia. Electronic address:

We report a case of invasive fungal sinusitis caused by Scopulariopsis in 57 year-old man who had recurrence of orbital cellulitis. CT-scan and magnetic resonance imaging found an orbital cellulitis associated to a left frontal sinusitis with bone erosion and calcification. Patient was treated by surgical debridement and voriconazole. Read More

Arch Soc Esp Oftalmol 2018 Oct 8;93(10):503-506. Epub 2018 Apr 8.

Unidad de Órbita y Oculoplástica, Servicio de Oftalmología, Hospital Universitario de Gerona Dr. Josep Trueta, Gerona, España.

Clinical Case: A 10-year-old girl was seen with a 3-week history of right upper lid swelling and with no other symptoms or fever. There was no recent history of sinusitis, trauma, or previous infection involving the periorbital area, or response to oral antibiotic treatment. Orbital computed tomography showed a lesion involving the upper margin of the orbit, and bone destruction at the orbital roof. Read More

Nepal J Ophthalmol 2017 Jul;9(18):180-186

Background: Sinonasal lymphomas are the commonest nonepithelial malignancies of the nasal cavity and paranasal sinuses. They may spread from their site of origin in nasal cavity and invade adjacent structures including orbits leading to varying presentation and a diagnostic dilemma.

Case: A-77- year old Nepalese male presented with swelling of left eye since 1 month and pain in the same eye since 2 days. Read More

BMC Ophthalmol 2018 Apr 10;18(1):88. Epub 2018 Apr 10.

Clinical Bacteriology Department, Amiens-Picardie University Hospital, Amiens, France.

Background: Clostridium perfringens is an uncommon pathogen in endophthalmitis, causing rapid destruction of ocular tissues. Clostridium perfringens infection typically occurs after penetrating injury with soil-contaminated foreign bodies.

Case Report: Here, we describe the case of a 17-year-old male who sustained a penetrating injury with a metallic intraocular foreign body and who rapidly developed severe C. Read More

Korean J Ophthalmol 2018 04 20;32(2):158-159. Epub 2018 Mar 20.

Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea.

J Contemp Dent Pract 2018 Mar 1;19(3):352-355. Epub 2018 Mar 1.

Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Pernambuco, Camaragibe, Brazil.

Introduction: Odontogenic infections originate from a tooth or from its supporting structures, generally secondary to a pulp necrosis, periodontal disease, pericoronitis, apical lesions, or complications of dental procedures, which can be restricted to the alveolus or can reach the jaws and face through maxillofacial spaces. These are the most common conditions which affect the head and neck regions.

Aim: The aim of this study is to report a severe case of a cervicofacial odontogenic infection while discussing the most relevant aspects. Read More

J Ophthalmic Inflamm Infect 2018 Mar 27;8(1). Epub 2018 Mar 27.

Department of Ophthalmology, Khon Kaen Hospital, Khon Kaen, Thailand.

Background: Ocular involvement in melioidosis is rare and has devastating outcomes. Although there have been few reports on the condition, Khon Kaen, a city in northeast Thailand, has been called the "capital of melioidosis" due to the high prevalence of the condition in the region. We retrospectively reviewed all admitted cases of melioidosis with ocular involvement from the two largest hospitals in Khon Kaen. Read More

Malays Fam Physician 2017 31;12(3):37-39. Epub 2017 Dec 31.

(Corresponding author) MBBs (Bangalore), Ms ORL-HNS (UKM) Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia email:

Background: Varicella has been known to be a harmless childhood disease. However, it has been reported that severe complications have taken place following Varicella infection, in both immunocompetent, as well as immunocompromised, individuals. Cutaneous complications of Varicella may manifest as preseptal cellulitis, albeit rarely. Read More

J Pediatric Infect Dis Soc 2018 Aug;7(3):e169-e171

Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.

An 11-year-old immunocompetent girl presented with two and a half months of progressive right orbital cellulitis, which did not respond to multiple courses of antibiotics or prednisone. A panfungal polymerase chain reaction primer was positive for Saksenaea vasiformis, and she completed 5 months of oral posaconazole therapy after debridement. Saksenaea vasiformis is a rare cause of zygomycosis, and it typically causes skin and soft tissue infection in immunocompetent hosts, particularly after a traumatic injury. Read More