Fungal pan-sinusitis with severe visual loss in uncontrolled diabetes

Abstract

Introduction: Invasive fungal pan-sinusitis can present atypically with severe acute visual loss with minimal anterior orbital inflammation. We describe 2 such cases with a background of uncontrolled diabetes.

Clinical picture: Respective clinical presentations of orbital apex and cavernous sinus syndromes were associated with isolation of Aspergillus galactomannan and Rhizopus.

Treatment: Urgent extensive surgical debridement and systemic antifungal is necessary.

Outcome: Clinical improvement of the ocular motor nerves can be expected within 2 months of treatment but visual loss is usually permanent.

Conclusion: Underlying pansinusitis is an important differential for acute visual loss, especially in uncontrolled diabetics. Early treatment determines outcome.