Fungal pan-sinusitis with severe visual loss in uncontrolled diabetes.

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.