Ocular Rhinosporidiosis Research Articles

Clinical Spectrum and Management Outcome of Ocular and Adnexal Rhinosporidiosis.

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

Ocular rhinosporidiosis- A case report

We report the clinical manifestations of ocular rhinosporidiosis and its management.A 25 years old male belonging from rural background, presented to Ophthalmology OPD after being referred from ENT OPD with a painless, reddish-pink, fleshy mass on white portion of the right eye. He had a similar looking mass inside his right nostril. He gave history of some unknown particle entering his right eye and nostril while watering the paddy fields and lesion developed in those places after 4-5 days.On examination, he had a fleshy, red-coloured mass attached to the bulbar conjunctiva of his right eye, supero-nasal to cornea, about 2.5 mms from the limbus. It had an elevated surface with vessels growing over it which did not bleed on touch. There were small whitish round to oval spots on the surface of the lesion.The patient was started with tablet Dapsone (100mg BD) for 3months and he underwent excision of conjunctival lesion under local anaesthesia along with cauterization at its base. The excised mass was sent for histopathological examination. Additionally, he was given topical Moxifloxacin (0.5% w/v) eye drops for 2weeks and systemic antibiotics (Amoxy-Clav 625mg BD for 5days) as post surgical prophylaxis. ENT surgeons excised the mass present on the nasal mucosa.The patient was diagnosed clinically to have conjunctival rhinosporidiosis. This was confirmed by histopathological examination. The patient was followed up for18 months and was asymptomatic with no recurrence of the lesions in the eye or nose.

Ocular Rhinosporidiosis and Recurrence Postsurgery: A Case Series

Rhinosporidiosis, a chronic granulomatous disease, is caused by Rhinosporidium seeberi. It is an endosporulating microorganism causing polypoidal ocular mass. A clinician needs to have high degree of suspicion for oculosporidiosis, as it is more common in nasal cavity and other respiratory passage as compared to ocular lesion. The authors intend to increase awareness among ophthalmologists through this case series. It was intended to evaluate profile, clinical presentation and recurrence rate of ocular rhinosporidiosis in a tertiary care setting in Eastern India. The present case series is about 15 patients diagnosed with rhinosporidiosis, that was reported within one year. Age range was 6-50 years, with male:female was 9:6. All patients underwent total excision with around 2 mm lesion free margin and electrocautery of base. Postoperatively, antibiotic and lubricant eye drops were given, a follow-up schedule was day 1, 7, 30, six months and one year. Majority of the patients showed involvement of lower tarsal conjunctiva (eight), followed by upper (four), then bulbar conjunctiva (one), lower lid (one), and lacrimal sac (one). All patients recovered completely postoperatively. At one year follow-up no patient had any recurrence. Ocular rhinosporidiosis may have diverse presentation from chalazion, papilloma, keratoconjunctivitis etc. This disease is often missed because of poor pathological back up at many centres. In an endemic area, a high degree of suspicion should be there to detect this relatively rare entity.

Comparison of Recurrence Rate in Excision of Conjunctival Rhinosporidiosis Mass with and without Cauterization of Base: A Randomized Clinical Trial

Aim: To compare the recurrence rate of conjunctival rhinosporidiosis mass excision, with and without cauterization of base.
 Study Design: Prospective randomized clinical trial.
 Place and Duration of Study: Department of Ophthalmology, CIMS, Bilaspur (C.G), India. (Feb 2018-Dec 2019)
 Methodology: Twenty patients (5-25years) who presented with conjunctival mass clinically diagnosed as ocular rhinosporidiosis were included in this study. Patients were recruited from OPD ophthalmology CIMS, Bilaspur (C.G). Patients were divided on alternate basis into two groups. Each group had 10 patients. Group1 included excisions with cauterization of base with wet field cautery and group 2 included excisions without cautery. All the procedures and post-operative evaluation were done by the same surgeon. These two groups were compared for recurrence of mass at the same site and other sites. Post-operative evaluation was done at 1 week, 1 month, 3 months and 6 months.
 Results: Patients’ age ranged between 5-15 years were more in both groups. There were more males than females and majority of them lived in rural areas where pond water was the only accessible portable water. Lower lid palpebral conjunctiva was more involved. The mean duration of lesion was similar in both groups. All the patients were examined at 1 week, 1 month, 3 months and 6 months post-operatively, to check for recurrence at the same site by the same surgeon. The ear, nose and throat was examined by an otolaryngologist. No recurrence was found after 6 months of the procedure at ocular and extra-ocular sites.
 Conclusion: Our study concludes that in cases of rhinosporidiosis mass of palpebral conjunctiva, total excision of mass without cauterization of base is as effective as with cauterization of base.

Evaluation of diagnosed cases of eye rhinosporidiosis in a public hospital of Maranh\xe3o, Northeast Brazil

BackgroundOculosporidiosis (ocular rhinosporidiosis) accounts for 15% of cases of rhinosporidiosis, which is a chronic granulomatous disease and is endemic in India and Sri Lanka. In Brazil, the climatic and hydrographic similarities to these endemic areas and the presence of riverside populations contributes to an increase in the incidence of rhinosporidiosis particularly in the State of Maranhão. This study, therefore, aimed to identify the number of diagnosed cases of oculosporidiosis and describe its the clinical epidemiology, laboratory, histopathology, and therapeutic characteristics.MethodsThe study is descriptive, observational, and cross-sectional, and reports the prevalence and clinical epidemiological characteristics of oculosporidiosis in the State of Maranhão, Brazil. A retrospective analysis of the paper and electronic records for a period from 1999 to 2017 was conducted in the University Hospital of Federal University of Maranhão (HU-UFMA), located in the northeastern region of Brazil.ResultsThirty patients were diagnosed with rhinosporidiosis, eight of them had oculosporidiosis and seven of these met the criteria to be included in the study. Of the cases (23.3% of all 30), five were men (71.4%) and two women (28.5%), with an average age of 16.4 ± 15.6 years. In terms of race, four patients (57.1%) declared themselves white and three (42.9%) as brown. The north of the state, the mesoregion, had the most diagnosed cases accounting for 57.1% of the total. Left eye was the most affected site, reported in six patients (85.7%), while the conjunctiva was affected in all patients. Rhinosporidiosis and papilloma were the predominant diagnostic hypotheses (28.5 and 28.5%, respectively), followed by chronic scleritis, granuloma, and chalazion (14.25, 14.25, and 14.25%, respectively). All these cases were treated with lesion excision, and only two patients (28.5%) progressed with recurrence.ConclusionIt was verified that there was a male predominance, with only one eye reported as an infected site, with no bilateral involvement. The younger age group (between 1 and 2 years of age) was more affected by oculosporidiosis, and histopathological examination was necessary for a conclusive diagnosis.

A single case report on Ocular Rhinosporidiosis

Rhinosporidiosis is an enigmatic disease which has been known to medicine since 1900. It is a chronic infestation caused by Rhinosporidium seeberi, which predominantly affects the mucus membrane of eye, nose and nasopharynx. We report a case of rhinosporidiosis with presentation of mass which looks like a chalazia present in left upper lid. Here the case ultimately managed by surgical resection followed by Ayurvedic treatment and antibiotic eye drops for a duration of one month. Despite it has chance of recurrence but here after an year also patient doesn’t have any complaints regarding the same. Here 24 year old female patient diagnosed with Rhinosporidiosis was advised to undergo Pratisarana followed with Bidalaka and later excision. Patient came for follow-up after 1 year, there was no recurrence as well as no complaints particular to rhinosporidiasis.

Ocular Rhinosporidiosis Presenting As A Rapidly Growing Conjunctival Papilloma

Ocular Rhinosporidiosis Presenting As A Rapidly Growing Conjunctival Papilloma

Clinical Profile and Treatment Outcome of Ocular and Adenexal Rhinosporidiosis - A 10 year Retrospective Study in a Tertiary Hospital in Western Odisha

Clinical Profile and Treatment Outcome of Ocular and Adenexal Rhinosporidiosis - A 10 year Retrospective Study in a Tertiary Hospital in Western Odisha

Ocular Rhinosporidiosis in a Nigerian Child: A Case Report and Literature Review from Niger Delta of Nigeria

Aim : The aim of this report is to raise the awareness of the existence of this rare ocular affliction in our locality and to highlight the importance of routine histopathological diagnosis of ocular mass lesions. Case Presentation: An 11 year old male school child presented to our centre with a 9 months history of a fleshy growth which bleeds spontaneously, on the inner aspect of the right upper eyelid. Other parts of both eyes including the left eye lid were normal A provisional diagnosis of squamous cell papilloma of the conjunctiva was made and the patient underwent an excisional biopsy of the lesion. Microscopic sections of the mass showed hyperplastic polypoid lesion with numerous globular cysts within the subepithelia conjunctiva with a surrounding of heavy inflammatory reaction composed of lymphocytes, plasma cells and neutrophils. A histopathological diagnosis of conjunctival rhinosporidiosis was made. Discussion: Rhinosporidiosis is a chronic localized granulomatous infection caused by an aquatic

Ocular rhinosporidiosis mimicking conjunctival squamous papilloma in Kenya – a case report

BackgroundOcular rhinosporidiosis is a chronic granulomatous infection caused by a newly classified organism that is neither a fungus nor bacterium. It often presents as a benign conjunctival tumour but may mimic other ocular conditions. It is most often described in India. In Africa cases have been reported from South Africa, Kenya, Tanzania, Malawi, Uganda, Congo and Ivory Coast.Case presentationA 54 year old man was seen in Kenya with a lesion that resembled a conjunctival papilloma. We report resemblance to conjunctival papilloma and the result of vital staining with 0.05% Toluidine Blue.ConclusionOcular rhinosporidiosis occurs in East Africa. It may resemble conjunctival squamous papilloma. Vital staining with 0.05% Toluidine blue dye did not distinguish the two lesions well.

Ocular rhinosporidiosis: a case report from Delhi

Rhinosporidiosis caused by Rhinosporidium seeberii, a protistal microorganism, is endemic in several parts of India. Infection involves mucous membranes of the nose and paranasal sinuses and usually manifests as vascular friable polyps. A few cases of rhinosporidoisis have been reported from Delhi, in patients who were migrants from other states. The present case constitutes the first report of rhinosporidiosis in a Delhi resident; the lesion occurred as polypoidal mass of the palpebral conjunctiva.

Ocular rhinosporidiosis presenting as recurrent chalazion

Rhinosporidiosis, a granulomatous disease caused by Rhinosporidium seeberi, is widely prevalent in Sri Lanka and southern parts of India. Besides the eye, the lacrimal passage and nasal cavity are affected. The most common ocular involvement is a subconjunctival bleeding mass. Our case, a 9-year-old girl from a rural background with a history of pond water bathing, presented with a marginal chalazion involving the left lower lid. She had a history of chalazion involving the same site three months earlier which was managed by incision and curettage. A decision of surgical exploration was made and the evacuated mass was examined histologically showing evidence of rhinosporidiosis. This type of clinical presentation for ocular rhinosporidiosis (as recurrent chalazion) has not been reported earlier in the literature. This case emphasises that the clinicians from this part of the world must consider ocular rhinosporidiosis as differential diagnosis in cases with recurrent chalazion especially in a rural background with a habit of pond water bathing.

Rinosporidiosis ocular, presentación de tres casos y revisión de la literatura científica

Ocular rhinosporidiosis is a very rare disease, caused by the parasite Rhinosporidium seeberi, which affects different organs including the conjunctiva. Because of its rarity is often underdiagnosed by ophthalmologists and pathologists. We present three cases that fulfilled the histological criteria of the disease and reviewed its clinical and pathological characteristics.

Ocular Rhinosporidiosis Presenting as Chronic Follicular Conjunctivitis in a Contact Lens Wearer

Ocular Rhinosporidiosis Presenting as Chronic Follicular Conjunctivitis in a Contact Lens Wearer

Lacrimal sac rhinosporidiosis.

Rhinosporidiosis is a disease caused by the organism Rhinosporidium seeberi, which is now believed to be a rare aquatic protistan parasite of fish. Ocular rhinosporidiosis is worldwide in distribution but relatively more common in India and Shrilanka. We report a retrospective case record of isolated lacrimal sac rhinosporidiosis in an 8 year male child from western Maharashtra. The clinical features, management and review of literature is discussed in brief.

THE EFFECTS OF BIOCIDES (ANTISEPTICS AND DISINFECTANTS) ON THE ENDOSPORES OF RHINOSPORIDIUM SEEBERI

No data exists on the activity of biocides (antiseptics and disinfectants) on Rhinosporidium seeberi that causes rhinosporidiosis in humans and animals. On account of the inability to culture R. seeberi, in vitro, dyes were used to assess the morphological integrity and viability of biocide-treated endospores that are considered to be the infective stage of this pathogen. Evan’s Blue (EvB) identifies the morphological integrity of the endospores while MTT (3-[4, 5-dimethylthiazol-2yl]-2, 5-diphenyl tetrazolium bromide) identifies metabolic activity through its reduction by cellular dehydrogenases to microscopically visible deposits of insoluble formazan. MTT-negativity has earlier been shown to correlate with absence of growth of yeast and mycelial fungi in culture and could thus indicate the loss of viability of MTT-negative rhinosporidial endospores. Hydrogen peroxide, glutaraldehyde, chloroxylenol, chlorhexidine, cetrimide, thimerosal, 70% ethanol, iodine in 70% ethanol, 10% formalin, povidone-iodine, sodium azide and silver nitrate were tested on freshly-harvested endospores and all biocides caused metabolic inactivation with or without altered structural integrity as shown by absence of MTT-staining after 3, 24 or 36 hour after exposure, while EvB stained only the endospores treated with sodium azide, ethanol, thimerosal, chloroxylenol, glutaraldehyde and hydrogen peroxide. With clinically useful biocides - chlorhexidine, cetrimide-chlorhexidine, 70% ethanol, povidone-iodine and silver nitrate, a total period of exposure of endospores to the biocide, for seven minutes, produced metabolic inactivation of the endospores. Anti-rhinosporidial antiseptics that could be used in surgery on rhinosporidial patients include povidone-iodine in nasal packs for nasal and naso-pharyngeal surgery, chlorhexidine and cetrimide-chlorhexidine on the skin, while povidone-iodine and silver nitrate could have application in ocular rhinosporidiosis.

Histopathologically confirmed ocular rhinosporidiosis in two Canadians

Case report: In India and Southeast Asia, rhinosporidiosis is a common infectious disease, but it has rarely been reported in western countries. Infrequently, isolated ocular rhinosporidial infections have been reported, but to our knowledge, there are no reported cases in Canada. Two cases of rhinosporidiosis have been recently diagnosed and managed at our university-based hospital. Comments: Rhinosporidiosis presents with certain characteristic clinical features; however, the diagnosis is confirmed histopathologically. The presence of typical sporangia and spores in a fibrovascular stroma infiltrated by acute and chronic inflammatory cells including granulomas is diagnostic. Surgical excision is the treatment of choice, and recurrence is possible but rare.

The effects of biocides (antiseptics and disinfectants) on the endospores ofRhinosporidium seeberi

No data exists on the activity of biocides (antiseptics and disinfectants) on Rhinosporidium seeberi that causes rhinosporidiosis in humans and animals. On account of the inability to culture R. seeberi, in vitro, dyes were used to assess the morphological integrity and viability of biocide-treated endospores that are considered to be the infective stage of this pathogen. Evan's Blue (EvB) identifies the morphological integrity of the endospores while MTT (3-[4, 5-dimethylthiazol-2yl]-2, 5-diphenyl tetrazolium bromide) identifies metabolic activity through its reduction by cellular dehydrogenases to microscopically visible deposits of insoluble formazan. MTT-negativity has earlier been shown to correlate with absence of growth of yeast and mycelial fungi in culture and could thus indicate the loss of viability of MTT-negative rhinosporidial endospores. Hydrogen peroxide, glutaraldehyde, chloroxylenol, chlorhexidine, cetrimide, thimerosal, 70% ethanol, iodine in 70% ethanol, 10% formalin, povidone-iodine, sodium azide and silver nitrate were tested on freshly-harvested endospores and all biocides caused metabolic inactivation with or without altered structural integrity as shown by absence of MTT-staining after 3, 24 or 36 hour after exposure, while EvB stained only the endospores treated with sodium azide, ethanol, thimerosal, chloroxylenol, glutaraldehyde and hydrogen peroxide. With clinically useful biocides - chlorhexidine, cetrimide-chlorhexidine, 70% ethanol, povidone-iodine and silver nitrate, a total period of exposure of endospores to the biocide, for seven minutes, produced metabolic inactivation of the endospores. Anti-rhinosporidial antiseptics that could be used in surgery on rhinosporidial patients include povidone-iodine in nasal packs for nasal and naso-pharyngeal surgery, chlorhexidine and cetrimide-chlorhexidine on the skin, while povidone-iodine and silver nitrate could have application in ocular rhinosporidiosis.

Ocular rhinosporidiosis in Tamil Nadu, India

A high incidence of ocular rhinosporidiosis in Kanyakumari district of Tamil Nadu, India is reported. Among the four taluks (sub-division for administration), highest occurrence was found in Agastheeswaram taluk (51.2%) followed by Kalkulam (24.4%), Thovalai (22%) and Vilavancode (2.4%). The disease occurred among both sexes equally and preponderance of a particular sex was not observed. The young adolescents were found to be more susceptible. The disease was found in all socio-economic strata and among all communities and persons belonging to different religious groups. Most of the patients gave a history of bathing in muddy stagnant pools of water.

Evaluation of the Clinical Profile and Treatment Outcomes of Ocular and Adnexal Rhinosporidiosis in a Tertiary Eye Care Centre

Aim: To describe the demographics, histopathology, treatment modalities, outcomes, and recurrence rates for patients diagnosed with ocular and adnexal rhinosporidiosis.Methods: This prospective descriptive study was conducted at the Department of Orbit, Oculoplasty, and Oncology at a tertiary eye care centre in South India. Fifty patients with a clinical diagnosis of ocular and adnexal rhinosporidiosis who presented from March 2005 to October 2007 were included. All patients underwent complete conjunctival and lid mass excision with cautery, and all patients with rhinosporidiosis of the lacrimal system underwent dacryocystectomy.Results: The mean age at presentation was 30.42 years (SD, 16.89 years; range, 1-70 years). The mean follow-up was 14.2 months (range, 12-18 months). The most common site was the conjunctiva (n = 26; 52%), followed by the lacrimal sac (n = 13; 26%) and the eyelids (n = 11; 22%). There was a single recurrence (2%) involving the lacrimal sac. Endonasal polypectomy and exploration of the sac region was done. There were no further recurrences during subsequent follow-up. The diagnosis was confirmed histopathologically for all patients.Conclusions: Rhinosporidiosis is an ocular disorder with high recurrence rates. Histopathological examination following excision biopsy is recommended for all patients for a conclusive diagnosis. Recurrence rates can be low if complete meticulous excision is performed coupled with cauterization of the lesion.