In this retrospective study, investigators examined the ophthalmic manifestations of patients with allergic fungal sinusitis (AFS).

Study design

Investigators reviewed charts from 100 patients who were seen at a tertiary hospital in Saudi Arabia with AFS over a 12-year period. Diagnostic criteria included the presence of type I hypersensitivity, asthma, nasal polyps, characteristic findings from CT imaging, and culture results.

Outcomes

The average age at presentation was 19.8 years, with no gender predilection. Ophthalmic manifestations were found in 34% of patients, including proptosis (62%), epiphora (15%), vision loss (12%), diplopia (9%), and globe dystopia (3%).

In 59% of cases, CT imaging showed bilateral disease, with heterogeneous sinus opacification (82%), erosion of the lamina papyracea (53%), and orbital (18%) or intracranial (9%) extension.

All patients showed improvement after endoscopic sinus surgery. While 20 patients required additional sinus surgery, none of these patients developed recurrent ophthalmic findings. Aspergillus species were grown from culture in 14 cases.

Limitations

The findings may not translate to all environments as regional pathogens may be involved.

Clinical significance

This very large series provides many useful insights into the clinical characteristics of this disease. Ophthalmologists may be the first to encounter a patient suffering from AFS, underscoring the importance of understanding its clinical presentation. In cases of sudden visual loss, early intervention may be beneficial in preventing permanent vision loss.