title: Fungal Orbital Cellulitis: Presenting Features, Management and Outcomes at a Referral Center.
abstract: OBJECTIVE
  To report a series of patients with fungal orbital cellulitis who underwent exenteration surgery and describe presenting features, management and outcomes at a referral center.
  
  
  METHODS
  Retrospective case series.
  
  
  RESULTS
  From November 2011 to March 2014, four patients underwent orbital exenteration for fungal orbital cellulitis at the University of Illinois. Three patients had mucormycosis and one had aspergillosis. All patients were treated with intravenous antifungals and underwent orbital exenteration. Two patients were successfully treated with supplemental intra-orbital catheter delivery of amphotericin B. Presenting visual acuity in the affected eye ranged from 20/25 to no light perception. Some level of ophthalmoplegia was present in three patients. Significantly elevated intraocular pressure was found in two patients. All patients with mucormycosis were found to have uncontrolled diabetes mellitus. One patient had a history of myelodysplastic syndrome, chronic hepatitis C infection, polysubstance abuse and Crohn's disease. Another patient had a history of alcoholic liver cirrhosis, Crohn's disease treated with systemic immunosuppression and renal cell carcinoma. The patient with aspergillosis had myelodysplastic syndrome and portal hypertension, and the initial presentation resembled giant cell arteritis. Two of four patients died during their hospitalization.
  
  
  CONCLUSIONS
  Fungal orbital cellulitis has a high mortality rate despite aggressive antifungal treatment and orbital exenteration performed soon after the diagnosis is confirmed. Patients often have a history of immunosuppression and the onset may be insidious. There must be a high rate of suspicion for fungal orbital cellulitis given the appropriate signs and medical history in order to avoid treatment delay.
authors.affiliation: Department of Ophthalmology, University of Illinois at Chicago College of Medicine , Chicago, Illinois , USA.
authors.forename: Asim V
authors.initials: AV
authors.lastname: Farooq
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Patel
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Lin
authors.forename: Pete
authors.initials: P
authors.lastname: Setabutr
authors.forename: Juliana
authors.initials: J
authors.lastname: Sartori
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Aakalu
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D017233:Orbit Evisceration; D054517:Orbital Cellulitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents
keywords: Aspergillosis; exenteration; mucormycosis; orbital cellulitis