Invasive fungal sinusitis can be a devastating condition, and accepted management is surgical debridement of infected tissue, systemic antifungal treatment and reversal of immunosuppression. Orbital involvement is common, affecting up to 75% of cases, and in advanced disease orbital exenteration may be indicated; however if this can be avoided it is clearly preferable. This paper looks at the use of transcutaneous retrobulbar injection of amphotericin B (TRAMB) as an alternative treatment, reviewing the literature and evaluating 15 papers. In total 610 eyes were evaluated, and 411 eyes were treated with TRAMB. The review showed a definite improvement in increased orbital salvage rate when TRAMB was used, although due to the understandably small numbers involved, this often failed to meet statistical significance. For subjects with localised orbital involvement, there was a 44.5% reduction in exenteration with TRAMB, and in patients with extensive orbital disease use of TRAMB reduced exenteration rate by 16%. Many studies found that use of TRAMB resulted in much improved visual acuity, with reported improvement rates of 38.9, 50% and 63.4% – but this was not consistently found in all studies, with some showing no difference. Findings in relation to ocular mobility were mixed, likewise with regard to radiological improvements. There were adverse effects reported in nine of 15 studies and these included transient chemosis and periorbital oedema, worsened visual acuity or ocular mobility, proptosis, ptosis and pain. One patient developed orbital compartment syndrome. In summary, this is an interesting paper that supports the use of TRAMB, outlines the diagnostic criteria for identifying suitable candidates, provides a detailed protocol for administering the intervention and includes essential safety advice. Worth a read!