Transcutaneous Retrobulbar Amphotericin B Injection Treatment for Invasive Fungal Rhino-Orbital Sinusitis - A Case Report

Sep 30, 2026

Invasive fungal rhino-orbital sinusitis is a rare, life-threatening infection, typically affecting immunosuppressed patients. This case report describes a 61-year-old diabetic woman receiving immunotherapy for breast cancer and systemic corticosteroids for sarcoidosis, presenting with severe headache, fever, and complete right visual loss. Imaging showed invasive pansinusitis with right orbital apex involvement, intracranial extension, and left medial orbital swelling. After right orbital exenteration, transcutaneous retrobulbar amphotericin B injections were delivered to the left orbit (1 mL of 3.5 mg/mL, six injections), achieving clinical stability and radiographic improvement.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Case Presentation

Case Reports in Ophthalmology | Case Rep Ophthalmol 2026;17:16–25 | | | --- | --- | | DOI: 10. 1159/000549100
Received: April 12, 2025
Accepted: October 15, 2025
Published online: December 11, 2025 | © 2025 The Author(s) .
Published by S. Karger AG, Basel [www.karger.com/cop](www.karger.com/cop) | This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([https://karger.com/Services/OpenAccessLicense](https://karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission. Case Report Transcutaneous Retrobulbar Amphotericin B Injection Treatment for Invasive Fungal Rhino-Orbital Sinusitis: A Case Report Ana Margarida Ferreira a José Maria Matos Sousab Joana Santos Oliveira a Vítor Leala Jorge Meiraa a Department of Ophthalmology, Local Health Unit São João, Porto, Portugal; bDepartment of Neuroradiology, Local Health Unit São João, Porto, Portugal Keywords Case report · Invasive fungal rhino-orbital sinusitis · Retrobulbar amphotericin B Abstract Introduction: Invasive fungal rhino-orbital sinusitis is a rare and life-threatening condition that occurs in immunosuppressed patients. This article aimed to describe the case of a patient with bilateral orbital mucormycosis treated with right orbital exenteration and transcutaneous retrobulbar amphotericin B (AMPB) in the left orbit. Case Presentation: A 61-year-old diabetic woman, immunosuppressed due to treatment with immunotherapy for breast cancer and systemic corticosteroid for sarcoidosis, was admitted to our hospital with complaints of severe headache, fever, and complete right visual loss. Imaging exams demonstrated an invasive pansinusitis with right orbital apex involvement, extension to frontal cerebral space and an inflammatory swelling in the medial aspect of the left orbit with extra-conal extension. These findings corroborated the diagnosis of rhino-orbital mucormycosis with intracranial extension. Initial treatment included systemic antifungal therapy and necrotic tissue debridement, both encephalic and sinonasal. Since there was a complete right orbital apex and optic nerve involvement, she was treated with right orbital exenteration. The left eye presented good visual acuity (8/10 Snellen chart) and no signs of afferent or efferent pathway involvement. Regarding the left orbital soft tissue involvement, this patient was proposed to transcutaneous retrobulbar injections of 1 mL of 3.5 mg/mL of AMPB. She received a total of 6 injections, with clinical stability and radiographic signs of improvement regarding the left orbital involvement of the infection. Conclusion: Transcutaneous retrobulbar injection of AMPB seems to be a valid approach for specific cases of rhinosinus mucormycosis with orbital invasion, allowing for orbital preservation without compromising patient survival. © 2025 The Author(s) . Published by S. KargerAG, Basel Correspondence to: Ana Margarida Ferreira, amargaridapferreira [gmail.com](gmail.com) Case Reports in Ophthalmology Case Rep Ophthalmol 2026;17:16–25 17 | DOI: 10. 1159/000549100 | © 2025 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/cop](www.karger.com/cop) | | --- | --- | Ferreira et al.: Transcutaneous RetrobulbarAMPB for invasive fungal rhino-orbital sinusitis Introduction Invasive fungal rhino-orbital sinusitis is a rare and life-threatening condition mostly observed in immunosuppressed patients. The filamentous Mucorales fungi represent a rare pathogenic agent causing this invasive infection, after Aspergillus and Candida. It is associated with a high mortality burden due to the aggressive nature of the infection [1] . In Portugal, the estimated incidence of mucormycosis is 0.9 cases/1 million inhabitants, which corresponds to an annual incidence of around 10 cases [2] . The mainstay of treatment of invasive mucormycosis involves prompt diagnosis of th

FAQs

What condition is described in this case report?

The report describes invasive fungal rhino-orbital sinusitis (mucormycosis), including bilateral orbital involvement and intracranial extension.

How was the infection treated?

The patient received systemic antifungal therapy and debridement, with right orbital exenteration due to complete right orbital apex and optic nerve involvement. The left orbit was treated with transcutaneous retrobulbar amphotericin B injections.

What were the outcomes after the amphotericin B injections?

After six transcutaneous retrobulbar AMPB injections to the left orbit, the patient remained clinically stable and showed radiographic signs of improvement in left orbital infection.

Sep 30, 2026

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