Invasive rhinosino-orbital aspergillosis with precipitous visual loss

Can J Ophthalmol. 1995 Apr;30(3):124-30.


Objective: To describe the clinicopathological and radiologic features in five cases of primary and secondary orbital aspergillosis.

Design: Case series.

Setting: Ophthalmology department of a university hospital.

Patients: Five patients over 65 years of age with invasive rhinosino-orbital aspergillosis.

Results: Presenting features were abrupt onset of proptosis, ophthalmoplegia and blepharoptosis with precipitous visual loss. All had debilitating periorbital pain or headache, but none had orbital inflammatory signs or appeared "toxic." Predisposing causes included alcoholism, low-dose prednisone therapy and insulin-dependent diabetes mellitus. One patient, suspected of having mucormycosis based on tissue biopsy and results of potassium hydroxide preparations, harboured Aspergillus fumigatus, which grew on culture. Secondary bacterial infections developed in three patients. Three patients died from their disease despite aggressive surgical treatment, including exenteration and sinus extirpation. The one patient with primary orbital aspergillosis survived after exenteration.

Conclusions: Sinonasal aspergillosis with orbital extension and primary orbital aspergillosis have a precipitous clinical course that mimics that of mucormycosis and may be fatal despite early exenteration. Computed tomography and magnetic resonance imaging of the sinuses, orbit and head provide complementary diagnostic signs. While results of potassium hydroxide preparations and tissue biopsy guide treatment of fungal infection, definitive diagnosis requires fungal culture. Relatively good vision may be associated with massive orbital and secondary intracranial extension.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aspergillosis / diagnosis*
  • Aspergillosis / microbiology
  • Aspergillosis / therapy
  • Aspergillus fumigatus / isolation & purification*
  • Blepharoptosis / diagnosis
  • Blepharoptosis / microbiology
  • Exophthalmos / diagnosis
  • Exophthalmos / microbiology
  • Eye Infections, Fungal / diagnosis*
  • Eye Infections, Fungal / microbiology
  • Eye Infections, Fungal / therapy
  • Fatal Outcome
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Ophthalmoplegia / diagnosis
  • Ophthalmoplegia / microbiology
  • Orbit / diagnostic imaging
  • Orbit / microbiology
  • Orbit / pathology
  • Orbital Diseases / diagnosis*
  • Orbital Diseases / microbiology
  • Orbital Diseases / therapy
  • Paranasal Sinus Diseases / diagnosis*
  • Paranasal Sinus Diseases / microbiology
  • Paranasal Sinus Diseases / therapy
  • Paranasal Sinuses / diagnostic imaging
  • Paranasal Sinuses / microbiology
  • Paranasal Sinuses / pathology
  • Tomography, X-Ray Computed
  • Vision Disorders / diagnosis*
  • Vision Disorders / microbiology
  • Vision Disorders / therapy