THE SPECTRUM OF ORBITAL ASPERGILLOSIS - A CLINICOPATHOLOGICAL REVIEW

Orbital aspergillosis is an uncommon but serious infection that may fi rst present to the ophthalmologist. Usually arising from the paranasal sinuses, it may present in manifold ways within the orbit. Some prese ntations, such as optic nerve involvement, can respond to systemic cor tico-steroids, leading to delays in diagnosis and possibly iatrogenic potentiation of the infectious process. In this review pertinent clini cal and radiographic findings are discussed, and the literature is sum marized. Classic approaches to therapy include local treatment, debrid ement, and systemic amphotericin B. We review novel approaches to trea ting orbital aspergillosis and detail a flow-chart for its management. Four patients from the spectrum of orbital aspergillosis are also des cribed: initially presenting as an infection of all exenteration socke t, a complex dacryocystitis, an optic nerve tumor, and post-operative periorbital swelling. Physicians should be familiar with the clinical spectrum of disease and the variable presentation of this infection, a s early diagnosis and rapid institution of appropriate therapy are cru cial elements in the management of invasive aspergillosis. In the neut ropenic or otherwise immunocompromised patient, a high index of suspic ion must be maintained as delays in diagnosis of fulminant aspergillos is may lead to overwhelming and rapidly progressive infection. Obtaini ng adequate diagnostic material for pathological and microbiological e xamination is critical. Newer methods of therapy, particularly itracon azole and liposomal amphotericin B, may be beneficial in selected pati ents.