Oculoplasty · Orbital cellulitis

Aspergillus flavus on SDA culture

Aspergillosis and mucormycosis are the most common orbital fungal infections, while aspergillosis is the most common cause of paranasal mycoses. Orbital mycoses typically occurs via extension from the paranasal sinuses, however, organisms can also gain access to the orbit from direct trauma or hematogenous spread from distant sites. The two species, Aspergillus flavus and Aspergillus fumigatus, most commonly affect the orbit. Management of aspergillosis consists of reversal of any immunosuppression, aeration and drainage of the paranasal sinuses involved, and treatment with systemic antifungals. Retrobulbar injection of amphotericin B can be considered. Surgical debridement of the orbit, sinuses and skull base with intravenous and local irrigation of antifungals may indicated for widespread invasive disease. Intravenous amphotericin B is considered the gold standard for medical treatment of sino-orbital aspergillosis. A lipid formulation of amphotericin B is available for patients with impaired renal function. Oral itraconazole is also commonly used as an alternative to or in combination with amphotericin B.Oral voriconazole has also been shown to be equally effective as primary therapy with fewer side effects.

Contributed byDr. Sahil KumarResident, Na

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