Fungal pan-sinusitis with severe visual loss in uncontrolled diabetes.
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.
Chua
Jocelyn L L
JL
Singapore National Eye Centre, Singapore. jocelynchua77@yahoo.com
Cullen
James F
JF
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
D000935:Antifungal Agents; D000946:Antigens, Fungal