Diagnosis and management of allergic fungal sinusitis with orbital involvement

W. J. Chang, D. T. Tse, K. L. Bressler, R. R. Casiano, T. E. Johnson

Research output: Contribution to journalArticle

Abstract

Purpose. Fungal sinusitis involving the orbit can be classified into four categories: 1) acute invasive. 2) chronic invasive, 3) mycetoma, and 4) allergic fungal sinusitis (AFS). The diagnostic cnieria and optimal treatment of AFS is uncertain. In this study the diagnostic criteria and Ireatment of AFS are examined. Methods. In a retrospective study three patients with the diagnosis of AFS were examined. All of the patients had the proposed diagnostic criteria: 1) sinusitis documented by radiographie examination, 2) histopathology consistent with allergic mucin, 3) fungal elements identified by histopathologic examination or culture, 4} no evidence of fungal invasion into the nasal mucosa or bone, and 5) immunocompetency. All of the patients were treated with surgical debridement and systemic corticosteroids. Antifungal medications were not used in these patients. Results. Age ranged from 10 to 21 years with a mean of 15 years. The followup ranged from 12 to 36 months with a mean of 23 months. Symptoms included prommenl eyes, nasal congestion, and headaches. Ocular findings included proptosis, lateral displacement of the globe, and increased resistance to retropulsion. None of the patients had visual impairment. All of the patients remained disease free as defined by no recurrent sinusitis, resolution of symptoms, and no ocular findings. Conclusions. Diagnostic criteria are proposed for AFS. These criteria are important in differentiating AFS from other fungal diseases of the sinuses. Surgical debridement and systemic Lorticosteroids are an effective treatment for AFS. Antifungal medication does not appear lo be necessary.

Original languageEnglish (US)
Pages (from-to)S115
JournalInvestigative Ophthalmology and Visual Science
Volume38
Issue number4
StatePublished - Dec 1 1997

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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