J Korean Ophthalmol Soc.  2020 Jul;61(7):834-838. 10.3341/jkos.2020.61.7.834.

Orbital Apex Syndrome Caused by Co-infection of Actinomyces with Invasive Fungal Sinusitis

• Yoon JS
• Hong SR
• Park HW

• KMID: 2504327
• DOI: http://doi.org/10.3341/jkos.2020.61.7.834

Abstract

Purpose
We report a case of orbital apex syndrome caused by co-infection of Actinomyces and Aspergillus invasive fungal sinusitis.
Case summary
An 87-year-old female visited our clinic for decreased visual acuity which began 2 weeks prior to her visit. She had a history of angina and uncontrolled diabetes. Her best-corrected visual acuity (BCVA) of the left eye was 0.2, the intraocular pressure was in the normal range, and mild ptosis with impaired abduction was noted. Gadolinium-enhanced brain magnetic resonance imaging showed left maxillary sinusitis and an enhanced lesion invading the pterygopalatine fossa. Functional endoscopic sinus surgery was performed by an otorhinolaryngologist. Pathology revealed co-infection with Aspergillus and Actinomyces. Her left BCVA was negative light perception despite surgery and impaired abduction progressed to total ophthalmoplegia.
Conclusions
We report a case of orbital apex syndrome caused by invasive fungal sinusitis with a rare co-infection of Actinomyces and Aspergillus.

Keyword

Actinomycosis; Aspergillosis; Invasive fungal infections; Orbital apex syndrome