title: Fungal pan-sinusitis with severe visual loss in uncontrolled diabetes.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Respective clinical presentations of orbital apex and cavernous sinus syndromes were associated with isolation of Aspergillus galactomannan and Rhizopus.
  
  
  METHODS
  Urgent extensive surgical debridement and systemic antifungal is necessary.
  
  
  RESULTS
  Clinical improvement of the ocular motor nerves can be expected within 2 months of treatment but visual loss is usually permanent.
  
  
  CONCLUSIONS
  Underlying pansinusitis is an important differential for acute visual loss, especially in uncontrolled diabetics. Early treatment determines outcome.
authors.affiliation: Singapore National Eye Centre, Singapore. jocelynchua77@yahoo.com
authors.forename: Jocelyn L L
authors.initials: JL
authors.lastname: Chua
authors.forename: James F
authors.initials: JF
authors.lastname: Cullen
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000032:analysis; D001228:Aspergillosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D001230:Aspergillus / Q000276:immunology / Q000302:isolation & purification; D003646:Debridement / Q000379:methods; D048909:Diabetes Complications / Q000097:blood / Q000150:complications* / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D012233:Rhizopus / Q000276:immunology / Q000302:isolation & purification; D012852:Sinusitis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed; D015354:Vision, Low / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
chemical_list: D000935:Antifungal Agents; D000946:Antigens, Fungal