Endoscopic Orbital Clearance/Debridement: A Potential Substitute for Orbital Exenteration in Rhino-orbital Mucormycosis

 Mucormycosis is an aggressive, lethal fungal infection affecting the nasal and paranasal territory in immunocompromised patients. Orbital involvement is not uncommon and may require orbital exenteration.  The management of orbital involvement in invasive fungal sinusitis is challenging, ranging from conservative retrobulbar amphotericin B injection in the early stages to orbital exenteration in late stages. Endoscopic endonasal debridement is a minimally invasive technique used to manage orbital fungal involvement in the late stages.  Endoscopic endonasal orbital clearance was performed to manage late-stage orbital invasive fungal infection (≥ stage 3c) or after failure of retrobulbar amphotericin B injection with no light perception. Removal of the lamina papyracea (LP) and incision of the periorbita were done to expose all the necrotic intraorbital content in the extra and intraconal spaces. A microdebrider was utilized to debride necrotic fungal infected tissue until a healthy vascularized plane was reached. Gelfoam (Pfizer Inc., New York, NY, United States) soaked in amphotericin B was applied as an adjunctive step to deliver antifungal medication to the orbital content.  Fourteen patients were included in the study, 9 of whom were male and 5 female, with a mean age of 58.5 years. Eleven patients showed no evidence of disease progression (complete recovery and cessation of medical treatment). Two patients died 15 days after the surgery. The last patient developed frontal lobe abscess but has been treated with double antifungal medication.  Endoscopic endonasal orbital debridement could be an effective method to treat late-stage orbital fungal infection without jeopardizing the patient's life. : 4.