Fungal pan-sinusitis with severe visual loss in uncontrolled diabetes

ABSTRACT

<p><b>INTRODUCTION</b>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.</p><p><b>CLINICAL PICTURE</b>Respective clinical presentations of orbital apex and cavernous sinus syndromes were associated with isolation of Aspergillus galactomannan and Rhizopus.</p><p><b>TREATMENT</b>Urgent extensive surgical debridement and systemic antifungal is necessary.</p><p><b>OUTCOME</b>Clinical improvement of the ocular motor nerves can be expected within 2 months of treatment but visual loss is usually permanent.</p><p><b>CONCLUSION</b>Underlying pansinusitis is an important differential for acute visual loss, especially in uncontrolled diabetics. Early treatment determines outcome.</p>