Journal of Clinical Case Reports

Orbital Apex Syndrome in a Patient with Sphenoethmoidal Fungal Rhinosinusitis

Abstract

Thanikachalam Subramanyan, Rakesh Singh, Karunanidhi Manickam, Jagadeeswaran Vadivel Udayakumaran, Neeta pal, Namrata Pal and Govind Pal

A 65 years old lady with uncontrolled diabetes mellitus came with Right Eye (RE) vision loss after 7 day history of drooping of RE upper lid. RE showed painful ophthalmoplegia and complete ptosis. Otorhinolaryngologica l (E.N.T.) examination detected edematous mucosa and mucopurulent discharge from sphenoethmoidal recess. Computed Tomography (C.T.) scan showed bilateral sphenoid and right ethmoidsinusitis with no intracranial spread. Most of the lesions were located at orbital apex with no bony erosion, as confirmed with Magnetic Resonance Imaging (MRI). Clinically, it was Orbital Apex Syndrome (OAS) due to noninvasive fungal rhinosinusitis. Treatment with antibiotics and antifungals was initiated. Functional Endoscopic Sinus Surgery (FESS) was electively done on 7th hospital day. Fungal masses were removed from sphenoid sinus and sent for histopathological study. Microbiological study showed Conidiobolus coronatus as causative agent. Conidiobolus rhinosinusitis leading to orbital apex syndrome is very rare. Probably the first reported case in India.