Levin L A, Avery R, Shore J W, Woog J J, Baker A S
Department of Ophthalmology, University of Wisconsin Medical School, Madison, USA.
Surv Ophthalmol. 1996 Sep-Oct;41(2):142-54. doi: 10.1016/s0039-6257(96)80004-x.
Orbital aspergillosis is an uncommon but serious infection that may first present to the ophthalmologist. Usually arising from the paranasal sinuses, it may present in manifold ways within the orbit. Some presentations, such as optic nerve involvement, can respond to systemic corticosteroids, leading to delays in diagnosis and possibly iatrogenic potentiation of the infectious process. In this review, pertinent clinical and radiographic findings are discussed, and the literature is summarized. Classic approaches to therapy include local treatment, debridement, and systemic amphotericin B. We review novel approaches to treating orbital aspergillosis and detail a flow-chart for its management. Four patients from the spectrum of orbital aspergillosis are also described: initially presenting as an infection of an exenteration socket, a complex dacryocystitis, and optic nerve tumor, and post-operative periorbital swelling. Physicians should be familiar with the clinical spectrum of disease and the variable presentation of this infection, as early diagnosis and rapid institution of appropriate therapy are crucial elements in the management of invasive aspergillosis. In the neutropenic or otherwise immunocompromised patient, a high index of suspicion must be maintained as delays in diagnosis of fulminant aspergillosis may lead to overwhelming and rapidly progressive infection. Obtaining adequate diagnostic material for pathological and microbiological examination is critical. Newer methods of therapy, particularly itraconazole and liposomal amphotericin B, may be beneficial in selected patients.
眼眶曲霉菌病是一种罕见但严重的感染性疾病，可能首先被眼科医生发现。该病通常起源于鼻窦，在眼眶内可表现为多种形式。一些表现，如视神经受累，可能对全身使用皮质类固醇有反应，从而导致诊断延迟，并可能医源性地加重感染进程。在本综述中，我们讨论了相关的临床和影像学表现，并对文献进行了总结。经典的治疗方法包括局部治疗、清创术和全身使用两性霉素B。我们回顾了治疗眼眶曲霉菌病的新方法，并详细介绍了其治疗流程图。我们还描述了4例眼眶曲霉菌病患者：最初表现为眼球摘除术后眼眶感染、复杂性泪囊炎、视神经肿瘤以及术后眶周肿胀。医生应熟悉该病的临床谱以及这种感染的多样表现，因为早期诊断和迅速采取适当治疗是侵袭性曲霉菌病管理的关键要素。对于中性粒细胞减少或其他免疫功能低下的患者，必须保持高度怀疑，因为暴发性曲霉菌病诊断的延迟可能导致感染迅速蔓延和病情进展。获取足够的诊断材料进行病理和微生物学检查至关重要。新的治疗方法，特别是伊曲康唑和脂质体两性霉素B，可能对部分患者有益。
