Acute Invasive Fungal Rhino-Orbital Sinusitis: Current Concepts and Controversies

Acute invasive fungal rhinosinusitis (AIFRS) is a fulminant angioinvasive infection that primarily affects immunocompromised patients and carries substantial morbidity and mortality. Orbital involvement presents particular diagnostic and therapeutic challenges and remains an area of controversy. This review summarizes current concepts in the classification, microbiology, diagnosis, and management of AIFRS, with emphasis on orbital involvement, termed acute invasive fungal rhino-orbital sinusitis (AIFROS). Early recognition, urgent imaging, histopathologic diagnosis, systemic antifungal therapy, debridement of necrotic tissue, and reversal of underlying immunosuppression remain the cornerstones of treating AIFRS. In contrast, management of AIFROS remains less standardized; globe-sparing approaches are increasingly employed in selected patients, as the literature has not demonstrated a clear survival benefit from orbital exenteration.