Oculomotor nerve palsy caused by invasive sphenoid sinus aspergillosis - Case report

Aspergillosis is the most common fungal infection of the paranasal sinuses. The maxillary sinus is the most frequently affected. Sphenoid sinus infection is less frequent. Its clinical significance is classified into noninvasive and invasive forms. Immunocompromised individuals are at higher risk for invasive infection. Once aspergillus invades the important structures surrounding the sphenoid sinus, it results in orbital complications. We encountered one diabetic patient who suffered from left oculomotor nerve palsy and ptosis caused by invasive sphenoid sinus aspergillosis in December 1998. Two months after endoscopic sphenoidotomy with extirpation of the fungal ball and irrigation, the orbital complications gradually resolved. We believe that awareness, suspicion, detailed examination, aggressive intervention and close follow-up are important for successful treatment.