Abstract
Objective
To evaluate the accuracy of the initial diagnosis in the case of fungal infections
of the orbit and identify factors that may influence patient outcomes.
Methods
An institutional review board–approved retrospective chart review was conducted across
2 large academic centres to identify cases of fungal infections involving the orbit
from January 1, 1998, to November 15, 2019. Data collected included patient demographics,
past medical history, examination findings, diagnosis, treatment, imaging, and outcomes.
Results
Fifty cases of fungal infection involving the orbit were identified. Of these, 33
(66.0%) were initially misdiagnosed as nonfungal diagnoses. Sixteen patients (32.0%)
received multiple initial diagnoses. The most common diagnoses on presentation were
bacterial cellulitis (n = 12 of 50; 24.0%) and bacterial sinusitis (n = 12 of 50;
24.0%). These were followed by vascular and orbital inflammatory conditions (n = 9
of 50; 18.0%): 5 patients (10.0%) were clinically diagnosed with giant cell arteritis,
3 (6.0%) with nonspecific orbital inflammation, and 1 (2.0%) with optic neuritis.
In this subset of patients, 77.8% (n = 7 of 9) were treated initially with systemic
steroids. Additional initial diagnoses included neoplastic mass lesions, mucocele,
dacryocystitis, cavernous sinus thrombosis, hemorrhage, tick-borne illness, allergic
rhinitis, and allergic conjunctivitis. Misdiagnosis was significantly correlated with
involvement of the masticator space on imaging (p = 0.04).
Conclusion
Fungal infections of the orbit are misdiagnosed in 2 of 3 cases. Nearly 15% of patients
who are later diagnosed with fungal disease of the orbit were initially treated with
systemic steroids. Misdiagnosis is more frequent when the masticator space is involved.
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Article Info
Publication History
Published online: May 04, 2022
Accepted:
April 8,
2022
Received in revised form:
February 12,
2022
Received:
December 10,
2021
Publication stage
In Press Corrected ProofFootnotes
Presented at: A version of this work was presented at the Fall Meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery, November 2020.
Identification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
