Journal of Rhinology 2008;15(2):148-151.
Published online November 30, 2008.
Blindness Secondary to Sphenoid Fungus Ball
Oh Jin Kwon, Sea Yuong Jeon, Kyung Su Kim, Jin Pyeong Kim
1Department of Otorhinolaryngology, Gyeong-Sang National University Hospital, Chinju, Korea.
2Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
접형동 국균증에 의한 실명 치험 1예
권오진, 전시영, 김경수, 김진평
경상대학교 의과대학 이비인후과학교실,1 연세대학교 의과대학 이비인후과학교실2
The close vicinity of the optic nerve to the sphenoid sinus may cause visual loss in the sphenoid fungus ball. We present a case of blindness secondary to sphenoid fungus ball without any evidence of orbital invasion in imaging studies. A 61-year-old man, suffering from uncomplicated diabetes, was referred for right visual loss that developed 1 day ago. He perceived hand motion on the right. CT and MRI revealed a fungus ball in the right sphenoid sinus. However, there was no evidence of orbital invasion. Endoscopic sphenoethmoidectomy was performed to remove the fungus ball. Systemic mega-dose steroid and amphotericin B were started because he lost the light perception 3 days after surgery. Biopsy revealed aspergillus fungus ball and no evidence of mucosal invasion. However, blindness was not reversed. Evidence of orbital invasion in imaging diagnosis is elusive in sphenoid fungus ball; therefore, systemic antifungal treatment should be initiated and early endoscopic sphenoidotomy should be performed in case of rapidly progressing visual loss, especially in diabetic or immunocompromised patients. Mega-dose steroid therapy for optic neuropathy should be selective because it may aggravate underlying systemic diseases to cause early termination of systemic antifungal treatment.
Key Words: Blindness;Sphenoid sinus;Fungus ball;Sphenoethmoidectomy

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