title: Non-Exenteration Management of Sino-Orbital Fungal Disease.
abstract: OBJECTIVE
  To describe the non-exenteration management of sino-orbital fungal infection, a life-threatening condition for which orbital exenteration is generally considered a first-line treatment.
  
  
  METHODS
  A retrospective case series is presented of 7 orbits in 6 consecutive patients admitted and treated at 2 major metropolitan tertiary teaching hospitals in Sydney, New South Wales, Australia.
  
  
  RESULTS
  Seven orbits in 6 consecutive patients with sino-orbital fungal infection were treated conservatively with surgical debridement and intravenous antifungal agents. Four patients were immunosuppressed and the other 2 patients were otherwise healthy. All presented with pain, proptosis, or loss of vision. Causative organisms found were Mucormycoses, Aspergillus, and Scedosporium prolificans. Exenteration was avoided in all patients as part of their planned management and 5 patients, including 1 with bilateral disease, survived their disease without exenteration. Medical treatment included intravenous liposomal amphotericin B or voriconazole. A single immunosuppressed patient deteriorated and as a last resort, exenteration was performed, but this made no difference to his clinical course and in retrospect could have been avoided as he died of multiple cerebral metastases diagnosed shortly after his deterioration.
  
  
  CONCLUSIONS
  The authors recommend that patients with sino-orbital fungal disease preferably be treated conservatively, without orbital exenteration.
authors: *Royal North Shore Hospital, St. Leonards; and †St. Vincent's Hospital, Darlinghurst, New South Wales, Australia.
authors: Dnyaneshwar D
authors: DD
authors: Athavale
authors: Robin
authors: R
authors: Jones
authors: Brett A
authors: BA
authors: O'Donnell
authors: Martin
authors: M
authors: Forer
authors: Nigel
authors: N
authors: Biggs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D003646:Debridement / Q000379:methods*; D019468:Disease Management; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification; D009091:Mucormycosis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D017233:Orbit Evisceration; D009916:Orbital Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents