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Objective <p>To characterize a highly occult subtype of sphenoid invasive fungal rhinosinusitis (IFRS) presenting as acute orbital apex syndrome (OAS) without classic invasive imaging signs, and to evaluate the efficacy of early surgical intervention.</p> Methods <p>This retrospective case series evaluated six patients (March 2021–November 2025) who developed classic OAS secondary to sphenoid IFRS despite strictly subtle imaging manifestations. All underwent navigation-guided endoscopic sinus clearance and optic nerve decompression. Pre- and postoperative neuro-ophthalmic parameters (best-corrected visual acuity [BCVA], visual field index [VFI], mean deviation [MD], and ocular motility) were analyzed. Bias-corrected effect sizes (Hedges' g) were calculated to quantify the magnitude of functional recovery.</p> Results <p>Pathological evaluation confirmed <i>Aspergillus fumigatus</i> (n=4), <i>Penicillium citrinum</i> (n=1), and <i>Rhizopus oryzae</i> (n=1). Four patients (66.7%) had comorbid type 2 diabetes. Following surgery, median BCVA improved from 1.91 to 0.30 LogMAR (Hedges’ g = 0.80). In the four patients completing visual field testing, median VFI improved from 11% to 91.5% (g = 1.37), and median MD improved from -28.02 to -3.33 dB (g = 1.23). Ocular motility fully recovered in two of three affected patients. Notably, the two patients lacking visual recovery presented with severe preoperative hyperglycemia (&gt;14 mmol/L). No severe surgery-related complications occurred.</p> Conclusions <p>For occult IFRS presenting with this striking 'clinical-radiological dissociation', early navigation-guided endoscopic exploration is a crucial sight-saving strategy. Strict glycemic control is paramount to preserving this therapeutic window. Further prospective validation is warranted.</p>

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Orbital apex syndrome caused by imaging-occult sphenoid sinus fungal infection and the necessity of early surgical exploration: a retrospective case series

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Zhixing Li,
  • Weibin Liu,
  • Yanchen Zhang,
  • Wencan Wu,
  • Yunhai Tu,
  • Jieliang Shi

摘要

Objective

To characterize a highly occult subtype of sphenoid invasive fungal rhinosinusitis (IFRS) presenting as acute orbital apex syndrome (OAS) without classic invasive imaging signs, and to evaluate the efficacy of early surgical intervention.

Methods

This retrospective case series evaluated six patients (March 2021–November 2025) who developed classic OAS secondary to sphenoid IFRS despite strictly subtle imaging manifestations. All underwent navigation-guided endoscopic sinus clearance and optic nerve decompression. Pre- and postoperative neuro-ophthalmic parameters (best-corrected visual acuity [BCVA], visual field index [VFI], mean deviation [MD], and ocular motility) were analyzed. Bias-corrected effect sizes (Hedges' g) were calculated to quantify the magnitude of functional recovery.

Results

Pathological evaluation confirmed Aspergillus fumigatus (n=4), Penicillium citrinum (n=1), and Rhizopus oryzae (n=1). Four patients (66.7%) had comorbid type 2 diabetes. Following surgery, median BCVA improved from 1.91 to 0.30 LogMAR (Hedges’ g = 0.80). In the four patients completing visual field testing, median VFI improved from 11% to 91.5% (g = 1.37), and median MD improved from -28.02 to -3.33 dB (g = 1.23). Ocular motility fully recovered in two of three affected patients. Notably, the two patients lacking visual recovery presented with severe preoperative hyperglycemia (>14 mmol/L). No severe surgery-related complications occurred.

Conclusions

For occult IFRS presenting with this striking 'clinical-radiological dissociation', early navigation-guided endoscopic exploration is a crucial sight-saving strategy. Strict glycemic control is paramount to preserving this therapeutic window. Further prospective validation is warranted.