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J.R. Carrasco, J.R. Bilyk, M.A. Stefanyszyn; Fungal Orbital Cellulitis: Clinical Comparison of Mucormycosis, Invasive Aspergillosis, and Allergic Aspergillosis . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4970.
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Purpose: To assess the clinical features distinguishing patients with fungal orbital cellulitis. Methods: A retrospective, observational case review of patients with fungal orbital cellulitis on the oculoplastics service of Wills Eye Hospital from 1993 to 2003 was performed. Results: : Twelve patients were found to have fungal orbital cellulitis–– four patients with Mucor, six patients with invasive aspergillosis, and two patients with allergic aspergillosis. The average duration of symptoms before presentation was 8 days for the Mucor patients, 212 days for the invasive aspergillosis patients, and 60 days for the allergic aspergillosis patients. NLP vision was found at presentation in 2/4 Mucor patients, 2/6 inv. aspergillosis patients, and 0/2 allergic aspergillosis patients. Most commonly, patients presented with proptosis and ophthalmoplegia. All patients with Mucor had sudden visual loss, while only 1 patient with invasive aspergillosis had acute visual loss. Pain was present in only 2/4 patients with Mucor. None of the patients were febrile. Imaging studies revealed most commonly contiguous sinus disease and orbital masses in all three types of fungal disease. Intracranial involvement was most common in invasive aspergillosis. Co–morbid disease was found in 4/4 Mucor patients, 4/6 inv. aspergillosis patients, and 1/2 allergic aspergillosis patients. Life threatening complications were found in 4/4 Mucor patients, 4/6 inv. aspergillosis, and in none of the allergic aspergillosis patients. Treatment modalities consisted of orbitotomy, endoscopic sinus surgery, and orbital catheters for the Mucor and inv. Aspergillosis patients. The best visual recovery was found in the allergic aspergillosis patients Conclusions: Patients with Mucor and invasive aspergillosis are almost clinically indistinguishable. Pathologic examination of involved orbital/sinus tissue must be performed to confirm the causative organism. However, the duration of symptoms may be the most helpful in differentiating the two entities. Also, acute visual loss presented most commonly in mucormycosis. Pain is not a distinguishing factor. Eschar is not present in a majority of Mucor patients. Treatment modalities were similar with the frequent use of orbital catheters in the Mucor and inv. Aspergillosis patients. In contrast, the allergic aspergillosis patients had a benign clinical course with excellent visual recovery and no life threatening complications.
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