Invasive fungal sinusitis presenting as acute posterior ischemic optic neuropathy

Rafat Ghabrial, Arjun Ananda, Sebastiaan J. van Hal, Elizabeth O. Thompson, Stephen R. Larsen, Peter Heydon, Ruta Gupta, Svetlana Cherepanoff, Michael Rodriguez, Gabor Michael Halmagyi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Invasive fungal sinusitis causes painful orbital apex syndrome with ophthalmoplegia and visual loss; the mechanism is unclear. We report an immunocompromised patient with invasive fungal sinusitis in whom the visual loss was due to posterior ischaemic optic neuropathy, shown on diffusion-weighted MRI, presumably from fungal invasion of small meningeal-based arteries at the orbital apex. After intensive antifungal drugs, orbital exenteration and immune reconstitution, the patient survived, but we were uncertain if the exenteration helped. We suggest that evidence of acute posterior ischaemic optic neuropathy should be a contra-indication to the need for orbital exenteration in invasive fungal sinusitis.

Original languageEnglish
Pages (from-to)209-214
Number of pages6
Issue number4
Publication statusPublished - 4 Jul 2018
Externally publishedYes


  • Invasive fungal sinusitis
  • orbital exenteration
  • posterior ischaemic optic neuropathy


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