Cyriac Jiji Tresa, Cherian Tambi, Hadi Wasna Ali, Jose Joyce
Department of Ophthalmology, Gulf Medical College Hospital and Research Centre, Gulf Medical University, Ajman, UAE.
J Neurosci Rural Pract. 2011 Jul;2(2):180-2. doi: 10.4103/0976-3147.83589.
An uncommon case of allergic fungal rhinosinusitis presented to the ophthalmology outpatient department of our hospital with complaints of blurred vision in the right eye of a few days duration and vague complaints of pain around the eyes. The visual acuity on examination was grossly reduced in the right eye and normal in the left eye. Color vision was normal. Anterior segment examination including pupils was normal. Dilated fundus examination was normal except for temporal pallor in the right optic disc. Automated perimetry and magnetic resonance imaging (MRI) scan of brain and orbit were done. The imaging report showed a bilateral pansinusitis with pressure on the right optic nerve. Perimetry showed a superior field defect on the right side. ENT consultation and computed tomography (CT) with contrast helped to diagnose this as a case of allergic fungal rhinosinusitis. The patient was started on systemic steroids under the care of the ENT surgeon. After a few days, pre-operative assessment showed a gross improvement of visual acuity. Endoscopic sinus surgery was done to remove the polyps and thick mucus material. Histopathologic examination confirmed allergic fungal mucin. Days after surgery, the visual acuity improved further and repeat perimetry showed gross improvement in the visual field. Good history taking and a detailed ophthalmic examination, keeping in mind the probable causes of loss of vision of few days duration with no findings other than a decreased visual acuity and a suspicious disc, were key to the early diagnosis and investigation in this case. This helped in early referral and management of the case before permanent damage and irreversible visual loss occurred. The optic nerve is a cranial nerve which, once damaged permanently, will not regenerate. The amount of sinus involvement was extensive on both sides and invariably the left optic nerve would have been involved in a few days, if intervention was delayed.
我院眼科门诊接诊了一例罕见的变应性真菌性鼻-鼻窦炎患者，患者主诉右眼视力模糊，持续数天，并伴有眼部周围隐痛。检查发现右眼视力明显下降，左眼视力正常。色觉正常。包括瞳孔在内的眼前节检查正常。散瞳眼底检查正常，但右侧视盘颞侧苍白。进行了自动视野检查以及脑部和眼眶的磁共振成像（MRI）扫描。影像学报告显示双侧全鼻窦炎，右侧视神经受压。视野检查显示右侧上半视野缺损。耳鼻喉科会诊及增强计算机断层扫描（CT）有助于诊断为变应性真菌性鼻-鼻窦炎。患者在耳鼻喉科医生的护理下开始使用全身类固醇治疗。几天后，术前评估显示视力有明显改善。进行了鼻内镜鼻窦手术以清除息肉和浓稠的黏液物质。组织病理学检查证实为变应性真菌黏蛋白。术后数天，视力进一步改善，重复视野检查显示视野有明显改善。详细询问病史并进行全面的眼科检查，同时考虑到持续数天视力丧失的可能原因，除视力下降和可疑视盘外无其他发现，是该病例早期诊断和检查的关键。这有助于在永久性损害和不可逆转的视力丧失发生之前对该病例进行早期转诊和治疗。视神经是一种脑神经，一旦受到永久性损伤，将无法再生。两侧鼻窦受累范围广泛，如果延迟干预，左侧视神经几天内必然也会受累。
