INVASIVE RHINOSINO-ORBITAL ASPERGILLOSIS WITH PRECIPITOUS VISUAL-LOSS

Objective: To describe the clinicopathological and radiologic features in five cases of primary and secondary orbital aspergillosis. Design: Case series. Setting: Ophthalmology department of a university hospit al. Patients: Five patients over 65 years of age with invasive rhinosi no-orbital aspergillosis. Results: Presenting features were abrupt ons et of proptosis, ophthalmoplegia and blepharoptosis with precipitous v isual loss. All had debilitating periorbital pain or headache, but non e had orbital inflammatory signs or appeared ''toxic,'' Predisposing c auses included alcoholism, low-dose prednisone therapy and insulin dep endent diabetes mellitus. One patient, suspected of having mucormycosi s based on tissue biopsy and results of potassium hydroxide preparatio ns, harboured Aspergillus fumigatus, which grew on culture, Secondary bacterial infections developed in three patients. Three patients died from their disease despite aggressive surgical treatment, including ex enteration and sinus extirpation. The one patient with primary orbital aspergillosis survived after exenteration. Conclusions: Sinonasal asp ergillosis with orbital extension and primary orbital aspergillosis ha ve a precipitous clinical course that mimics that of mucormycosis and may be fatal despite early exenteration. Computed tomography and magne tic resonance imaging of the sinuses, orbit and head provide complemen tary diagnostic signs. While results of potassium hydroxide preparatio ns and tissue biopsy guide treatment of fungal infection, definitive d iagnosis requires fungal culture. Relatively good vision may be associ ated with massive orbital and secondary intracranial extension.