Ekta Aggarwal1, Kaustubh Mulay2, Vikas Menon3, Gangadhara Sundar4, Santosh G Honavar5, Mukesh Sharma6. 1. Drishti Eye Care and Vasan Eye Care Hospitals, Hyderabad, India. Electronic address: drektaoph@gmail.com. 2. National Reporting Centre for Ophthalmic Pathology (NRCOP), Centre For Sight, Hyderabad, India. 3. Oculoplastics, Facial Aesthetics and Ocular Oncology, Centre For Sight, New Delhi, India. 4. Orbit and Oculofacial Surgery, Department of Ophthalmology, National University Hospital, Singapore. 5. Oculoplastics, Facial Aesthetics and Ocular Oncology, Centre For Sight, Hyderabad, India. 6. Oculoplastics, Facial Aesthetics and Ocular Oncology, Centre For Sight, Jaipur, India.
Abstract
OBJECTIVE: To report clinicopathologic features, radiologic findings, and treatment outcomes of isolated, orbital aspergillosis. DESIGN: Multicenter, retrospective case series. METHODS: setting: Multicenter. PARTICIPANTS: There were 8 lesions in 8 eyes of 8 patients with isolated, orbital aspergillosis. PROCEDURE: Review of medical records and histopathology slides. MAIN OUTCOME MEASURES: Disease control. RESULTS: Of 34 patients with orbital aspergillosis, 8 (23.5%) had isolated orbital involvement at presentation. The mean age at presentation was 34.5 years (median, 43 years: range, 0.5-72 years). Gradually progressive proptosis and eyelid swelling were the most common presenting features (each 4/8). Proptosis ranged from 4 mm to 9 mm (median, 5.5 mm; mean, 5.75 mm). Restriction of ocular motility was seen in all 8 patients. Other examination findings included palpable mass (2/8), conjunctival chemosis (2/8), hyperglobus (1/8), hypoglobus (1/8), and resistance to retropulsion (1/8). Microbial culture results were available in 1 patient and showed Aspergillus fumigatus. Two patients were treated with complete surgical excision alone while 6 were treated with antifungal medications. Complete resolution of proptosis and restoration of ocular motility were seen in all patients following treatment. Visual disturbances present in 1 were corrected following treatment. Recurrence was observed in 1 patient. CONCLUSION: Isolated orbital aspergillosis, though rare, should be considered in the differential diagnosis of a patient presenting with a gradually progressive orbital mass, especially in Asian individuals. Early recognition will help reduce the morbidity and mortality associated with this disease.
OBJECTIVE: To report clinicopathologic features, radiologic findings, and treatment outcomes of isolated, orbital aspergillosis. DESIGN: Multicenter, retrospective case series. METHODS: setting: Multicenter. PARTICIPANTS: There were 8 lesions in 8 eyes of 8 patients with isolated, orbital aspergillosis. PROCEDURE: Review of medical records and histopathology slides. MAIN OUTCOME MEASURES: Disease control. RESULTS: Of 34 patients with orbital aspergillosis, 8 (23.5%) had isolated orbital involvement at presentation. The mean age at presentation was 34.5 years (median, 43 years: range, 0.5-72 years). Gradually progressive proptosis and eyelid swelling were the most common presenting features (each 4/8). Proptosis ranged from 4 mm to 9 mm (median, 5.5 mm; mean, 5.75 mm). Restriction of ocular motility was seen in all 8 patients. Other examination findings included palpable mass (2/8), conjunctival chemosis (2/8), hyperglobus (1/8), hypoglobus (1/8), and resistance to retropulsion (1/8). Microbial culture results were available in 1 patient and showed Aspergillus fumigatus. Two patients were treated with complete surgical excision alone while 6 were treated with antifungal medications. Complete resolution of proptosis and restoration of ocular motility were seen in all patients following treatment. Visual disturbances present in 1 were corrected following treatment. Recurrence was observed in 1 patient. CONCLUSION: Isolated orbital aspergillosis, though rare, should be considered in the differential diagnosis of a patient presenting with a gradually progressive orbital mass, especially in Asian individuals. Early recognition will help reduce the morbidity and mortality associated with this disease.