Fungal pan-sinusitis with severe visual loss in uncontrolled diabetes.

INTRODUCTION Invasive fungal pan-sinusitis can present atypically with severe acute visual loss with minimal anterior orbital inflammation. We describe 2 such cases with a background of uncontrolled diabetes. CLINICAL PICTURE Respective clinical presentations of orbital apex and cavernous sinus syndromes were associated with isolation of Aspergillus galactomannan and Rhizopus. TREATMENT Urgent extensive surgical debridement and systemic antifungal is necessary. OUTCOME Clinical improvement of the ocular motor nerves can be expected within 2 months of treatment but visual loss is usually permanent. CONCLUSION Underlying pansinusitis is an important differential for acute visual loss, especially in uncontrolled diabetics. Early treatment determines outcome.