Invasive Fungal Sinusitis Can Threaten Vision Health

Man with sore eye
Most fungal sinusitis is noninvasive, but when it spreads to the orbit and central nervous system, morbidity and mortality can be high if left untreated.

This article is part of Optometry Advisor’s conference coverage from the 2021 meeting of the American Academy of Optometry, held in Boston from November 3 to 6, 2021. The team at Optometry Advisor will be reporting on a variety of the research presented by the primary eye care experts at the AAO. Check back for more from the AAO Optometry 2021 Meeting..

When patients develop fungal sinus infections, their eyes can be affected as well. Therefore, patients suspected of having invasive fungal sinusitis should be evaluated by an otolaryngologist immediately, as early surgical debridement improves outcomes, according to a poster presented by Kelly Malloy, OD, FAAO, at American Academy of Optometry 2021 conference in Boston, held November 3-6.

In the case study presented, an 85-year-old woman sought urgent care for left eye redness and photophobia, and severe pain in and around the left eye and face. She exhibited dyschromatopsia and visual field defects in the left eye, which suggested early optic neuropathy, anterior chamber inflammation and low intraocular pressure. 

The patient underwent functional endoscopic sinus surgery and resectioning of a left sphenoid sinus fungal ball 2 years earlier. Due to concern for recurrent fungal sinusitis, she was sent to a hospital emergency department, where she was diagnosed and treated for bacterial sinusitis. However, when her symptoms worsened and neuroimaging studies revealed concerning findings, she was referred to another hospital emergency department. There, she underwent revision endoscopic sinus surgery for left sphenoid fungal sinusitis with osteitis, which resolved all ocular signs and symptoms.

“Although most fungal sinusitis is noninvasive, rarely invasive fungal sinusitis can spread to the orbit and central nervous system, with high morbidity and mortality if not properly treated,” Dr Malloy explained. 

As such, fungal rhinosinusitis should be considered if the patient has a history of fungal sinusitis, is immunocompromised, and complains of facial pain or other sinus symptoms, according to Dr Malloy. However, while neuroimaging helps determine diagnosis, a definitive diagnosis can only be made via a biopsy. 

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Malloy K. Painful red eye secondary to fungal sinusitis with osteitis. Paper Presented at: American Academy of Optometry 2021 Annual Meeting; November 3-6, 2021; Boston. Board #135.