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. 2022 Nov 30;34(3):341-346.
doi: 10.4103/joco.joco_33_22. eCollection 2022 Jul-Sep.

Clinical Spectrum and Management Outcome of Ocular and Adnexal Rhinosporidiosis

Md Shahid Alam  1 , Neha Shrirao  2
Affiliations

Clinical Spectrum and Management Outcome of Ocular and Adnexal Rhinosporidiosis

Md Shahid Alam et al. J Curr Ophthalmol. .

Abstract

Purpose: To describe the clinical spectrum and management outcomes of ocular rhinosporidiosis.

Methods: All histopathologically diagnosed cases of ocular rhinosporidiosis between January 2000 and December 2016 were included in the study. The lesions were classified based on the site of involvement, namely conjunctiva, lacrimal sac, eyelid, and orbit. The frequency and percentages for each of the lesions and the different treatment modalities were noted and calculated. Any recurrence and its subsequent management were also noted.

Results: A total of 34 patients were included with a male-to-female ratio of 2.7:1. Conjunctiva was the most common site involved (19, 55.8%), followed by lacrimal sac (11, 32.3%) and eyelid (3, 8.82%). One patient had orbital involvement secondary to sinonasal extension. The mean duration of symptoms was 14.8 ± 19.1 months (range, 1-84 months). Seven (36.8%) patients in the conjunctival group needed scleral patch graft. Five patients (45.4%) with lacrimal sac rhinosporidiosis underwent dacryocystectomy and modified dacryocystorhinostomy (DCR). The mean follow-up period was 5.43 ± 7.9 months (range, 1-36 months). Five (14.7%) patients (2 conjunctival, 2 lacrimal, and 1 eyelid) had recurrence.

Conclusions: Conjunctiva is the most common site for ocular rhinosporidiosis, followed by lacrimal sac. While conjunctival lesions respond well to complete excision with cauterization of the base, lacrimal sac lesions can be managed by a modified DCR. Eyelid rhinosporidiosis can mimic a neoplasm and should be considered in differential diagnosis in suspicious lesions, especially in endemic areas.

Keywords: Conjunctiva; Eyelid; Lacrimal; Orbit; Rhinosporidiosis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) External photograph showing a reddish mulberry-like lesion from the upper palpebral conjunctiva resembling a pyogenic granuloma. (b and c) Slit-lamp photograph showing a reddish mass from the inferior and bulbar conjunctival surfaces respectively. Notice the pinhead-sized yellowish dots over the surface of the lesion depicting rhinosporidial sporangia
Figure 2
Figure 2
(a) External photograph showing swelling in the left lacrimal sac region. (b) Computed tomography scan of the orbit showing a soft tissue lesion in the left lacrimal sac extending into the inferior meatus. (c) Nasal endoscopy showing mass in the inferior meatus. (d) Microphotograph showing rhinosporidial sporangia in different stages of maturation
Figure 3
Figure 3
(a) External photograph showing left eye proptosis and chemosis. Notice the scar in the lacrimal sac region from the previous surgery. (b) Nasal endoscopy showing mass in the nasal cavity. (c) Rhinosporidiosis of the oropharynx. (d) Magnetic resonance imaging orbit showing mass in the medial orbit extending to the lacrimal sac region, ethmoid sinus and nose. (e) Resolution of proptosis and chemosis after debulking and dapsone therapy. (f) Microphotograph showing rhinosporidial sporangia in different stages of maturation
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