Compressive optic neuropathy secondary to sphenoid sinus aspergillosis

The authors report a case of retrobulbar optic neuropathy caused by noninvasive isolated sphenoid sinus aspergillosis. A 62-year-old woman suffered from left temporal headache with progressive visual loss in the left eye. Relative afferent pupillary defect, normal appearance of optic disc, and elevated erythrocyte sedimentation rate were found. Under the impression of posterior ischemic optic neuropathy caused by giant cell arteritis, urgent pulse therapy with corticosteroids was administered. Later, endoscopic sphenoid sinus surgery was undertaken following computed tomography and magnetic resonance imaging, which demonstrated a heterogenous mass lesion in the left sphenoid sinus. A fungal ball was removed from the sphenoid sinus, and acute-angled branching, septate hyphae were seen on pathological examination. Fungus culture grew Aspergillus fumigatus. The patient's best-corrected visual acuity improved to 20/400 in the left eye after a six-month follow-up period.