J Korean Ophthalmol Soc.  2014 Mar;55(3):426-431. 10.3341/jkos.2014.55.3.426.

A Case of Optic Neuropathy Caused by Fungal Ball in an Onodi Cell

• Han YS
• Yang CM
• Shin JH
• Park IK

• KMID: 2218274
• DOI: http://doi.org/10.3341/jkos.2014.55.3.426

Abstract

PURPOSE
To report a rare case of optic neuropathy caused by a fungal ball in an Onodi cell.
CASE SUMMARY
A 63-year-old female was referred to our clinic with relapsed visual loss and ocular pain in the right eye. She had been diagnosed as optic neuritis 14 days before and given pulse steroid therapy. She recovered to normal but relapsed 7 days before. In medical referral there was no suspected multiple sclerosis but only a few inflammation in the paranasal sinuses. On our initial examination, best corrected visual acuity was counting finger at 10 cm in the right eye, and 1.0 in the left eye, along with relative afferent pupillary defect in the right eye. The fundoscopic examinations disclosed disc swelling; nearly total visual field defect was observed on visual field examination and visual evoked potential test revealed decreased amplitude at P100 wave in the right eye. Clinical impression was relapsed optic neuritis. After the administration of pulse steroid therapy, her disc swelling was decreased and visual acuity was recovered to 0.6, however, visual acuity was exacerbated to 0.4 in 2 weeks. We checked outside brain magnetic resonance imaging (MRI) and the result showed optic neuropathy caused by a fungal ball in an Onodi cell. The patient was referred to otorhinolaryngologist and fungal ball was removed by endoscopic sinus surgery. 3 weeks after surgery the patient's visual acuity was 0.9, no disc swelling was found and visual evoked potential was recovered to normal.
CONCLUSIONS
An Onodi cell lesion should be considered in the differential diagnosis of optic neuritis, identified by imaging studies and promptly removed by surgery for visual recovery.

Keyword

Fungal ball; Fungal sinusitis; Onodi cell; Optic neuropathy

MeSH Terms

Brain
Diagnosis, Differential
Evoked Potentials, Visual
Female
Fingers
Humans
Inflammation
Magnetic Resonance Imaging
Middle Aged
Multiple Sclerosis
Optic Nerve Diseases*
Optic Neuritis
Paranasal Sinuses
Pupil Disorders
Referral and Consultation
Visual Acuity
Visual Fields

Figure

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  Figure 1. Initial ophthalmic findings (A) In fundus photograph, disc swelling and redness was found in the right eye. (B) Automated visual field examination revealed nearly total visual field defect in the right eye. (C) Pattern visual evoked potential examination revealed no definite P100 wave in the right eye.

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  Figure 2. MRI (A-F) and CT (G), (H). (A) In Onodi cell, axial T2-weighted MRI showed peripheral high signal intensity and low signal intensity inside. (B) Axial T1-weighted MRI showed peripheral iso signal intensity and high signal intensity inside. (C, D, E) Axial T2,T1 and enhanced axial T1-weighted MRI showed laterally ex-tended Onodi cell. (F) Enhanced coronal T1-weighted MRI showed non-enhanced optic nerve and thicken optic nerve sheath. Mass in Onodi cell surround and compress optic nerve. (G, H) Axial and coronal CT showed calcifi-cation in mass (arrow: fungal ball in Onodi cell, PE: posterior ethmoid sinus, ON: optic nerve, arrowhead: calcifi-cation in Onodi cell).

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  Figure 3. Histologic finding of aspergillosis (Hematoxylin and eosin stain, ×400): Septated hypae and septa branch at a 45-degree angle.

Reference

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