Proptosis, the protrusion of the eyeball from the orbit, results from a wide variety of pathologies that can be vision-or life-threatening. Clinical history, associated physical exam findings, and imaging features are all crucial in establishing the underlying etiology. The differential diagnosis is broad, and includes infectious, inflammatory, vascular, and neoplastic entities that range from benign and indolent, to malignant and aggressive. While treatment varies significantly based on the disease process, all are aimed at preserving vision, salvaging the globe, preventing disfigurement, and reducing mortality. Both internists and general ophthalmologists should be familiar with the causes of proptosis in order to initiate the work-up for, and appropriately triage, affected patients.

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Acumed assisted iliac crest bone graft harvest is a safe technique in which substantial amount of cancellous bone can be obtained. The low risk of bowel perforation can be further minimized by limiting the depth of drill bit penetration to less than 3 cm.

Background Hypochlorous acid has both anti-microbial and wound healing properties with a growing role for use in pre-procedural care on the face. Objectives To compare the antiseptic property of 0.01% hypochlorous solution (HA), 5% povidone iodine (PI), 4% chlorhexidine (CHG) and 70% isopropyl alcohol (IPA) antiseptic on facial skin. Methods A prospective single-center clinical trial. Results A total of 21 participants were recruited. Bacterial growth was seen in CHG (10%), IPA (71%), PI (81%) and HA (95%) of specimens (p < 0.001). CHG had less growth when compared to HA (p = <0.001), IPA (p = <0.001) and PI (p = <0.001). No difference in bacterial growth was seen between HA and IPA (p = 0.063) or HA and PI (p = 0.25). Significant differences in mono-microbial and poly-microbial growth was seen between HA and IPA (p = 0.046) and HA and CHG (p= < 0.001). Staphylococcus epidermidis grew less frequently in CHG (10%), followed by IPA (29%), PI (71%) and HA (71%). Staphylococcus capitis grew less frequently in CHG (0%), followed by PI (14%), HA (24%) and IPA (29%). Conclusions CHG reduced the bacterial growth compared to HA, PI, and IPA. However, HA, PI and IPA had insignificant differences in bactericidal effects. Our study provides a supporting role of HA to be considered as an antiseptic.

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