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Invasive fungal sinusitis: treatment of the orbit
Evan Kalin-Hajdu1, Kristin E Hirabayashi, M Reza Vagefi
1Department of Ophthalmology; University of California, San Francisco, California, USA.
Purpose Of Review:
To summarize diagnostic techniques for invasive fungal rhinosinusitis and provide a review of treatment options once disease has spread to the orbit.
Recent Findings:
Improved imaging criteria, polymerase chain reaction and other serologic tests show promise in advancing our ability to accurately diagnose invasive fungal disease. Currently, there exists three treatment options for infected orbital tissue: exenteration, conservative debridement and transcutaneous retrobulbar injection of amphotericin B. Exenteration, the most frequently reported intervention, has not been proven to enhance survival. Conservative debridement and transcutaneous retrobulbar injection of amphotericin B are increasingly considered reasonable first-line options.
Summary:
Although investigative tools are improving, invasive fungal rhinosinusitis can still pose a diagnostic challenge. No one treatment option for the orbit has been proven superior to another. Therefore, it is justified to initiate therapy by prioritizing less morbid procedures. If deterioration is continually noted, more invasive interventions can then be employed. The treatment algorithm established at our institution is provided.
Insights
Diagnosing invasive fungal rhinosinusitis remains challenging despite advances. Less invasive treatments for orbital spread are preferred initially for fungal rhinosinusitis, with escalation if needed.
Area of Science:
- Otolaryngology
- Ophthalmology
- Infectious Diseases
Background:
- Invasive fungal rhinosinusitis (IFR) presents diagnostic challenges.
- Orbital involvement necessitates careful consideration of treatment strategies.
Purpose of the Study:
- To review diagnostic techniques for IFR.
- To summarize treatment options for IFR with orbital spread.
Main Methods:
- Literature review of diagnostic modalities.
- Analysis of treatment outcomes for orbital IFR.
Main Results:
- Advanced imaging and molecular tests (e.g., PCR) improve IFR diagnosis.
- Treatment options for orbital IFR include exenteration, debridement, and retrobulbar amphotericin B.
- Exenteration has not demonstrated improved survival; less invasive options are emerging as first-line.
Conclusions:
- IFR diagnosis remains difficult despite improved tools.
- No single orbital treatment for IFR is definitively superior.
- Prioritizing less morbid procedures is recommended, with escalation for persistent disease.
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