Blindness Secondary to Sphenoid Fungus Ball

The close vicinity of the optic nerve to the sphenoid sinus may cause visual loss in the sphenoid fungus ball. We present a case of blindness secondary to sphenoid fungus ball without any evidence of orbital invasion in imaging studies. A 61-year-old man, suffering from uncomplicated diabetes, was referred for right visual loss that developed 1 day ago. He perceived hand motion on the right. CT and MRI revealed a fungus ball in the right sphenoid sinus. However, there was no evidence of orbital invasion. Endoscopic sphenoethmoidectomy was performed to remove the fungus ball. Systemic mega-dose steroid and amphotericin B were started because he lost the light perception 3 days after surgery. Biopsy revealed aspergillus fungus ball and no evidence of mucosal invasion. However, blindness was not reversed. Evidence of orbital invasion in imaging diagnosis is elusive in sphenoid fungus ball; therefore, systemic antifungal treatment should be initiated and early endoscopic sphenoidotomy should be performed in case of rapidly progressing visual loss, especially in diabetic or immunocompromised patients. Mega-dose steroid therapy for optic neuropathy should be selective because it may aggravate underlying systemic diseases to cause early termination of systemic antifungal treatment.

A Case of Sphenoid Sinus Mucocele / 대한이비인후과학회지

Mucocele of the sphenoid sinus is a rare disease, and its signs and symptoms are different depending on multiple contiguous neurologic and vascular structures. So it is occasionally misdiagnosed as pituitary tumors. But careful radiologic evaluation including CT scan, helps in the correct assessment of this lesion. We have recently experienced one case of sphenoid sinus mucocele which presented with subtle nasal symptom. The mucocele was removed by endoscopic intranasal sphenoethmoidectomy.