Ophthalmic manifestations of allergic fungal sinusitis

PURPOSE: To highlight allergic fungal sinusitis as a cause of ophthalmic an d sinus problems by identifying the profile of the patient with allergic fu ngal sinusitis and presenting a successful treatment approach. METHODS: Six consecutive cases of patients with ophthalmic manifestations o f allergic fungal sinusitis were reviewed. Ophthalmic findings, sinus invol vement, mycology, immune response, imaging studies, and treatment were exam ined, The characteristics of this patient group with ophthalmic manifestati ons of allergic fungal sinusitis were compared with those of the general gr oup of patients with allergic fungal sinusitis. RESULTS: All six patients had proptosis, One had symptomatic diplopia and o ne had visual loss. Imaging studies, fungal characterization, and immune pr ofiles were similar to the reported allergic fungal sinusitis population, A fter treatment there was no recurrence of ophthalmic or sinus symptoms at a mean follow up of 34 months (range, 8 to 48 months). There were no complic ations of treatment. CONCLUSIONS: Initial diagnosis of allergic fungal sinusitis requires suspic ion on the part of the ophthalmologist, Proptosis is the most common ophtha lmic sign. Differentiation from invasive forms of fungal sinus dis ease is crucial, because systemic antifungal medication and extensive surgical tiss ue debridement are not required in allergic fungal sinusitis. Treatment con sists of extirpation of the allergic mucin and fungus, sinus aeration, and systemic and topical corticosteroids. (Am J Ophthalmol 1999;127:189-195. (C ) 1999 by Elsevier Science Inc. All rights reserved,)