Orbital complications in allergic fungal rhinosinusitis: a case series from a tertiary center hospital experience.

Background: Allergic fungal rhinosinusitis (AFRS) is a non-invasive form of sinus inflammation characterized by immunoglobulin E (IgE)-mediated eosinophilic-rich type 1 hypersensitivity reaction. Although it is uncommon, many ophthalmic manifestations such as ophthalmoplegia, proptosis, double vision, and even visual loss can be seen in patients with AFRS due to direct optic nerve compression, immunological reaction to fungi, or other mechanisms. Case Description: In this case series, we reviewed four different cases of AFRS patients with orbital complications, reviewing their clinical and radiological features, and describing their management and outcomes. A variety of mechanisms have been described as the leading cause of visual complications in AFRS, such as optic nerve compression or allergic inflammatory reaction causing bony destruction. However, imaging and histopathological analysis play an important role in diagnosis. Despite the presence of orbital complications, endoscopic sinus surgery is still considered the first line of management in these conditions, as these four cases showed resolution of the disease with no recurrence after at least 6 months follow-up. Conclusions: The diagnosis of AFRS can be challenging and results in the presence of complications in those patients. This study described the importance of early recognition, diagnosis, and intervention of this disease to avoid the orbital complications and preserve the vision of patients and prevent any permanent complications. However, further studies are still needed in the future to identify the pattern of these complications in the long term.