Reversible Neuropraxic Visual Loss Induced by Allergic Aspergillus Flavus Sinomycosis

Abstract

This work reports a patient with visual loss treated successfully with surgical removal of the Aspergillus flavus sinomycosis. Vision was partially reversed within hours after surgery before starting planned corticosteroid therapy. The patient's visual acuity continued to improve steadily until it became equal to that of the other eye. The immediate gain in vision and continued improvement without corticosteroid therapy suggest a new hypothesis for visual loss induced by allergic sinonasal Aspergillosis. Simple mechanical pressure alone of the aspergillus mass over the nerve can produce visual loss, and this loss is reversed by removing the mass without corticosteroid therapy.

Optic nerve compression in allergic fungal sinusitis

“…The condition can be challenging to treat but is fortunately rare, with only a few published reports. [5][6][7][8][9][10][11][12][13] We encountered optic nerve involvement leading to visual loss in 10 cases of allergic fungal sinusitis treated over a 10-year period from June 1997 to May 2007. Our experience with these cases is reported.…”

Allergic Fungal Sinusitis Induced Visual Loss and Optic Neuropathy

“…[12][13][14][15] Marple et al report rapid recovery of visual acuity after surgical decompression in patients with AFS and propose that AFS related visual loss is similar to visual loss with mucoceles concluding that surgical decompression should be the primary form of treatment for AFS related visual loss. 13 They considered visual loss related to compression to be more likely to recover than infectious and inflammatory conditions such as invasive bacterial orbital rhinosinusitis.…”

“…12 Our own review of the literature shows that 33 patients have been reported with partial or complete visual loss from AFS. 2,7,[12][13][14][15][18][19][20][21][22][23][24][25][26][27][28][29] Furthermore, 20 of the 33 patients have documented follow up of visual function, subjective or objective, after treatment. Sixteen of 20 patients showed improvement of their visual function.…”

“…Optic neuropathy has been attributed by some authors to direct compression of the optic nerve and by others to a secondary optic neuritis due to contiguous inflammation. [12][13][14][15] Here we present a case of a patient with neuroimaging and clinical evidence of an optic neuropathy secondary to pathologically proven AFS.…”

Allergic Fungal Rhinosinusitis in the Lesser and Greater Wings of the Sphenoid With Resultant Optic Neuropathy: A Case Report and Review of the Literature

“…Visual loss associated with allergic fungal sinusitis is an uncommon finding (1.46% to 3.7 %) [29]. The pathophysiology of visual loss in patients with allergic fungal sinusitis has been proposed to be either through direct or indirect optic nerve compression, or through an inflammatory process that results in optic neuritis [29][30][31][32][33].…”