Ophthalmic manifestations of allergic fungal sinusitis.
OBJECTIVE
To highlight allergic fungal sinusitis as a cause of ophthalmic and sinus problems by identifying the profile of the patient with allergic fungal sinusitis and presenting a successful treatment approach.


METHODS
Six consecutive cases of patients with ophthalmic manifestations of allergic fungal sinusitis were reviewed. Ophthalmic findings, sinus involvement, mycology, immune response, imaging studies, and treatment were examined. The characteristics of this patient group with ophthalmic manifestations of allergic fungal sinusitis were compared with those of the general group of patients with allergic fungal sinusitis.


RESULTS
All six patients had proptosis. One had symptomatic diplopia and one had visual loss. Imaging studies, fungal characterization, and immune profiles were similar to the reported allergic fungal sinusitis population. After treatment there was no recurrence of ophthalmic or sinus symptoms at a mean follow-up of 34 months (range, 8 to 48 months). There were no complications of treatment.


CONCLUSIONS
Initial diagnosis of allergic fungal sinusitis requires suspicion on the part of the ophthalmologist. Proptosis is the most common ophthalmic sign. Differentiation from invasive forms of fungal sinus disease is crucial, because systemic antifungal medication and extensive surgical tissue debridement are not required in allergic fungal sinusitis. Treatment consists of extirpation of the allergic mucin and fungus, sinus aeration, and systemic and topical corticosteroids.
Department of Ophthalmology and Visual Sciences, University of Iowa College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA.
K D
KD
Carter
S M
SM
Graham
K M
KM
Carpenter
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005094:Exophthalmos / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005658:Fungi / Q000302:isolation & purification; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D007073:Immunoglobulin E / Q000032:analysis; D008297:Male; D009181:Mycoses / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000382:microbiology; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D005938:Glucocorticoids; D007073:Immunoglobulin E