J Korean Ophthalmol Soc.  2017 Apr;58(4):455-458. 10.3341/jkos.2017.58.4.455.

A Case of Fungal Ball Causing Acute Dacryocystitis

• Hwang YS
• Yang HJ
• Paik JS
• Yang SW

• KMID: 2376602
• DOI: http://doi.org/10.3341/jkos.2017.58.4.455

Abstract

PURPOSE
We report a case of fungal ball after Endoscopic Dacryocystorhinostomy (DCR) in a 40-year-old female patient.
CASE SUMMARY
A 40-year-old female patient was admitted to our hospital for left lower eyelid tenderness and bloody discharge from the lacrimal punctum. During a planned endoscopic DCR, the sac was opened after the osteotomy, and 2 fungal balls were found in the lacrimal sac. The masses were 7 × 5 mm and, 9 × 5 mm sized, irregularly shaped, and red in color. Aspergillus fumigatus was diagnosed pathologically. Postoperative paranasal sinus magnetic resonance imaging showed no residual fungal ball. During follow-up, the patient showed patent rhinostomy opening, and there was no evidence of fungal infection on nasal endoscopic finding.
CONCLUSIONS
Although Aspergillus fumigatus is a rare cause of canalicular obstruction, fungal ball development in the lacrimal sac can cause acute dacryocystitis.

Keyword

Acute dacryocystitis; Aspergillus fumigatus; Dacryocystorhinostomy (DCR); Fungal ball

MeSH Terms

Adult
Aspergillus fumigatus
Dacryocystitis*
Dacryocystorhinostomy
Eyelids
Female
Follow-Up Studies
Humans
Lacrimal Apparatus
Magnetic Resonance Imaging
Nasolacrimal Duct
Osteotomy

Figure

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  Figure 1. Gross finding of mass. 7 × 5 mm, 9 × 5 mm sized, ir-regularly shaped, red colored 2 fungal balls obstructing the lac-rimal sac.

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  Figure 2. Histologic finding of fungal ball (Periodic acid– Schiff stain, ×200). Numerous septated branched fungal hy-phae with degeneration and inflammatory cells, consistent with Aspergillosis.

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  Figure 3. Paransal sinus magnetic resonance imaging (MRI), showing left ethmoid sinusitis. There is no remained visible fungal ball. (A) Coronal T2 MR image. (B) Axial T2 MR image.

Reference

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