Compressive Optic Neuropathy from Allergic Fungal Sinusitis

Tong, Jessica; Jefferson, Niall; Chaganti, Joga; Fraser, Clare L.

doi:10.3109/01658107.2015.1056380

Cited by 5 publications

(9 citation statements)

References 16 publications

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“…8 Of the cases reported, a high percentage of adult patients had some level of visual recovery of their affected eye indicating the importance of early clinical recognition and treatment. 8,9 Several reports describe rapid recovery of visual acuity after surgical decompression suggesting surgical intervention as the primary form of treatment. Here, we present a case that stands out by both the young age of our patient and the lack of visual recovery after surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Distinguishing AFS from acute invasive fungal sinusitis through microbiologic examination is crucial because the effectiveness of corticosteroids varies depending on the causative species. 9…”

Section: Discussionmentioning

confidence: 99%

“…Corticosteroids may have therapeutic value, as visual loss from AFS has been proposed to be not only secondary to direct nerve fiber compression but also due to orbital inflammatory changes causing optic neuritis. 8,9 In addition, clinicians should be aware that AFS symptoms may resemble those of other forms of fungal sinusitis. Distinguishing AFS from acute invasive fungal sinusitis through microbiologic examination is crucial because the effectiveness of corticosteroids varies depending on the causative species.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of visual loss from AFS ranges from 1.46% to 3.7% 8 . Of the cases reported, a high percentage of adult patients had some level of visual recovery of their affected eye indicating the importance of early clinical recognition and treatment 8,9 . Several reports describe rapid recovery of visual acuity after surgical decompression suggesting surgical intervention as the primary form of treatment.…”

Section: Discussionmentioning

confidence: 99%

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Permanent Unilateral Vision Loss From Allergic Fungal Sinusitis

O'Donnell

Kane²

2021

Pediatr Emer Care

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In the absence of trauma, sudden unilateral painless visual loss is an uncommon condition in the pediatric population requiring emergent medical evaluation. In the acute care setting, clinicians face the challenge of accurately assessing the patient and determining the initial diagnostic workup. A careful history alone helps guide diagnosis with sudden visual loss that is unilateral and persistent. Several neuro-ophthalmological conditions that present with these characteristics include retinal artery or vein occlusion, diseases affecting the cavernous sinus or orbital apex region, and optic neuropathy. Simple eye examination techniques have crucial diagnostic value in helping localize the disease process, determining the level of urgency, and need for timely intervention. Here we present an adolescent patient with nontraumatic, acute unilateral visual loss who had concerning ophthalmological examination findings and was subsequently diagnosed with optic neuropathy secondary to allergic fungal sinusitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Permanent Unilateral Vision Loss From Allergic Fungal Sinusitis

O'Donnell

Kane²

2021

Pediatr Emer Care

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“…[20, 21] Besides, the swelling of paranasal sinus in patients with CRS can also lead to compressive injury of optic nerve and following compressive ON as revealed in previous studies. [18, 22] In addition, the inflammatory process accounts for the majority of etiology for ON including the viral, autoimmune-related or idiopathic subtypes. [23] The elevated inflammatory mediators including interleukin and IgE in the CRS might elevate the local inflammatory reaction,[24–26] then lead to the occurrence or progression of ON.…”

Section: Discussionmentioning

confidence: 99%

The development of optic neuropathy after chronic rhinosinusitis: A population-based cohort study

Nien

Lee

et al. 2019

PLoS ONE

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Background To evaluate the risk of developing optic neuropathy (ON) in patient with both non-surgery and surgery-indicated chronic rhinosinusitis (CRS) via the national health insurance research database in Taiwan. Methodology/Principal findings 44,176 Patients with a diagnostic code of CRS was selected, which included 6,678 received functional endoscopic sinus surgery (FESS) regarded as the surgery-indicated CRS. Each individual in the study group was matched to two non-CRS patients by age and gender. The outcome was set as the occurrence of ON according to the diagnostic codes occurred after the index date. Poisson regression was used to calculate the adjusted relative risk (aRR) and conditional Cox proportional model was used to estimate the adjusted hazard ratio (aHR). There were 131 and 144 events of ON occurred in the study group and the control group respectively during the follow-up period. The whole study group, whether received FESS or not, demonstrated both significant aRR and aHR compared to the control group after adjusting demographic data, prominent ocular diseases, and systemic co-morbidities. In addition, both the aRR and aHR were higher in CRS patient received FESS than those with CRS but without FESS management. Conclusion The existence of CRS, especially the surgery-indicated CRS is a significant risk factor for the following ON using multivariable analysis.

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Catastrophic Allergic Fungal Sinusitis: A Report of Two Cases

Walter¹,

McKean²,

Camelo-Piragua³

et al. 2020

Journal of Neuro-Ophthalmology

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Background: Allergic fungal rhinosinusitis (AFRS) is a common condition in which sinusitis develops as an IgE-mediated response to common sinonasal fungal organisms. If that response leads to blockage of sinus ostia, bone expansion and erosion by expansive cysts containing dense inspissated debris may occur with the potential for critical neurovascular compression including damage to the anterior visual pathway. Methods: Review of clinical and imaging features of 2 patients who sustained catastrophic clinical outcomes. Results: The first patient had pansinusitis with massive mucocele-like cysts expanding the sphenoid sinus and cranial base and causing compression of the anterior visual pathway that led to persistent severe vision loss despite extensive sinus surgery. The second patient developed sphenoethmoidal expansion with a marked inflammatory response and presumed conversion to invasive fungal sinusitis that caused anterior visual pathway vision loss, bilateral ocular motor palsies from extension into the cavernous sinuses, and death from a large middle cerebral artery stroke. Conclusions: Although AFRS is most often benign and treatable, it may rarely produce catastrophic outcomes, especially if the sphenoid sinus is involved. Irreversible vision loss may occur from compression, and ocular motor palsies and death from conversion to invasive fungal disease. Close ophthalmologic and imaging monitoring is necessary in patients with expanded sinuses, and prophylactic sinus surgery may be indicated in certain cases.

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Compressive Optic Neuropathy from Allergic Fungal Sinusitis

Cited by 5 publications

References 16 publications

Permanent Unilateral Vision Loss From Allergic Fungal Sinusitis

Permanent Unilateral Vision Loss From Allergic Fungal Sinusitis

The development of optic neuropathy after chronic rhinosinusitis: A population-based cohort study

Catastrophic Allergic Fungal Sinusitis: A Report of Two Cases

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