Visual loss in the setting of allergic fungal sinusitis: pathophysiology and outcome

AbstractObjective:To hypothesise the probable pathophysiological mechanism responsible for visual loss in allergic fungal sinusitis, other than direct compression.Design:Retrospective, non-randomised case series. Out of 274 cases of allergic fungal sinusitis, four cases with sudden visual loss were enrolled into the study. The fourth case had visual loss on the contralateral side to bony erosion of the lateral wall of the sphenoid sinus.Interventions:All four cases were evaluated with fungal smear, immunoglobulin (Ig) E titres, visual evoked potentials, non-contrast computed tomography and magnetic resonance imaging of the paranasal sinuses, and fundus examination. They then underwent endoscopic sinus debridement followed by intravenous methylprednisolone.Outcome measures:Improvement in vision.Results:All four cases experienced an improvement in vision: full recovery in three cases and partial improvement in one case.Conclusion:In view of the operative, radiological and laboratory findings for case four, with the suggestion of a hyperimmune response to fungal antigens (in the form of raised IgE titre and positive fungal serology), we suggest that a local immunological reaction to fungal antigens might be responsible for the observed visual loss in cases of allergic fungal sinusitis, in addition to mechanical compression of the optic nerve.

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Allergic fungal sinusitis eroding the pterygoid plates: a rare case series

Brazilian Journal of Otorhinolaryngology ◽

10.1016/j.bjorl.2014.05.028 ◽

2015 ◽

Vol 81 (1) ◽

pp. 109-112

Author(s):

Osama Marglani ◽

Ahmed Masood Shaikh

Keyword(s):

Rare Case ◽

Case Series ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis

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Optic nerve compression in allergic fungal sinusitis

The Journal of Laryngology & Otology ◽

10.1017/s0022215110002689 ◽

2011 ◽

Vol 125 (4) ◽

pp. 381-385 ◽

Cited By ~ 5

Author(s):

A Thakar ◽

P Lal ◽

M Dhiwakar ◽

S Bahadur

Keyword(s):

Optic Nerve ◽

Visual Loss ◽

Univariate Analysis ◽

Tertiary Care ◽

Nerve Compression ◽

Fungal Sinusitis ◽

Tertiary Care Centre ◽

Allergic Fungal Sinusitis ◽

Urgent Surgery ◽

Optic Nerve Compression

AbstractObjective:To describe the syndrome of optic nerve involvement in cases of allergic fungal sinusitis.Setting:Academic tertiary care centre.Methods:Analysis of prospectively accrued data for 10 consecutive cases (three bilateral, giving 13 eyes) with visual loss secondary to optic nerve compression, from a total of 70 cases of allergic fungal sinusitis undergoing surgical treatment between June 1997 and May 2007.Results:The mean duration of rhinological symptoms prior to the onset of visual loss was 22 months. At presentation, visual loss ranged from a visual acuity of 6/12 to complete loss of light perception. Bilateral involvement was noted in three of the 10 cases. Urgent surgical decompression with removal of all fungal debris and decompression of the optic nerve resulted in visual recovery in seven of the 13 eyes. On univariate analysis, recovery was less likely in cases with long standing visual loss, and in cases with complete visual loss.Conclusion:Long standing allergic fungal sinusitis may be complicated by visual loss due to compression of the optic nerve. Urgent surgery to clear the sinuses and decompress the optic nerve is successful in reversing visual loss in cases with partial visual loss.

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Response of Visual Loss in Allergic Fungal Sinusitis to Oral Corticosteroids

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940511400315 ◽

2005 ◽

Vol 114 (3) ◽

pp. 247-249 ◽

Cited By ~ 8

Author(s):

Scott M. Graham ◽

Keith D. Carter

Keyword(s):

Visual Loss ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Medical Comorbidities ◽

Oral Corticosteroids

Visual loss associated with allergic fungal sinusitis is most often treated with surgery followed by oral corticosteroids. A case is presented in which, because of substantial medical comorbidities, surgery could not be initially performed and the visual loss was corrected with prednisone alone. This case serves to reinforce the central role of corticosteroids in treatment of this enigmatic condition.

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Allergic fungal sinusitis presenting as visual loss and facial dysmorphia in New York City

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2004.12.804 ◽

2005 ◽

Vol 115 (2) ◽

pp. S198

Author(s):

S. Kearney ◽

M. Ellman ◽

C. Wertenbaker ◽

W. Mak ◽

B. Silverman ◽

...

Keyword(s):

New York ◽

New York City ◽

York City ◽

Visual Loss ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Facial Dysmorphia

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Allergic Fungal Sinusitis-Induced Visual Loss

American Journal of Rhinology ◽

10.2500/105065899781389740 ◽

1999 ◽

Vol 13 (3) ◽

pp. 191-195 ◽

Cited By ~ 46

Author(s):

Bradley F. Marple ◽

Scott R. Gibbs ◽

Mark T. Newcomer ◽

Richard L. Mabry

Keyword(s):

Visual Loss ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis

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33 A subtype of allergic fungal sinusitis(AFS) with laboratory findings similar to allergic bronchopulmonary aspergillosis (ABPA)

Journal of Allergy and Clinical Immunology ◽

10.1016/s0091-6749(96)80251-x ◽

1996 ◽

Vol 97 (1) ◽

pp. 191-191

Author(s):

S RUBINSTEIN

Keyword(s):

Allergic Bronchopulmonary Aspergillosis ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Laboratory Findings

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Noninvasive fungal rhinosinusitis: a case series

F1000Research ◽

10.12688/f1000research.67204.1 ◽

2021 ◽

Vol 10 ◽

pp. 869

Author(s):

Mohamed Masmoudi ◽

Jihene Chelli ◽

Asma Ben Mabrouk ◽

Ezer Chebil ◽

Wadii Thabet ◽

...

Keyword(s):

Case Series ◽

University Hospital ◽

Fungal Sinusitis ◽

Allergic Fungal Sinusitis ◽

Fungal Rhinosinusitis ◽

Management Protocol ◽

Middle Meatal Antrostomy ◽

Definition Of ◽

Histopathological Results ◽

The University

Introduction: Fungal rhinosinusitis (FRS) remains a rare disease. The noninvasive forms are hard to diagnose. The management protocols remain controversial. We aim to describe the clinical, radiological and pathological features of noninvasive FRS and present our management protocol and follow-up results. Patients and methods: This descriptive study was conducted in the ear-nose-throat department of the university hospital, Taher Sfar in Mahdia, Tunisia. All patients who responded to the definition of noninvasive FRS (fungal balls and allergic fungal sinusitis) were included. The study was conducted over a three year period (May 2017 – April 2021). Results: Eleven patients were included in this study: four cases of fungal balls and seven cases of allergic fungal sinusitis. Patients presented with symptoms of chronic recurrent rhinosinusitis with no response to conventional treatments. Computed tomodensitometry scan showed opacification of the paranasal sinuses in all patients. Other signs were heterogeneous opacities, local calcifications and thinning of the bony walls of the sinuses. Histopathological findings were inflammatory polyps in all cases of allergic FRS with the presence of fungal hyphae in 42.8% of the cases. All patients underwent surgery after a median delay of 12 [6–24] months of the symptom’s onset. The used procedures were endoscopic middle meatal antrostomy for all patients, ethmoidectomy (81.8%) and sphenoidotomy (36.4%). None received systemic antifungals or corticosteroids with a favorable outcome in all cases. Conclusion: Symptoms of noninvasive FRS are nonspecific. The scan images contribute to the diagnosis, but the perioperative findings and the histopathological results remain crucial. The management is mainly surgical.

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