Vannessa Leung, Hamish Dunn, Brett O?Donnell
Purpose. Sinusitis complicated by orbital apex syn- drome is rare. The majority of cases reported in the literature are of mucormycosis in immunocompro- mised patients. We report a case of orbital apex syn- drome secondary to pseudomonas sinusitis in a diabetic patient.
Methods. Retrospective case report of a diabetic patient with orbital apex syndrome secondary to pseudomonas sinusitis presenting to a tertiary oph- thalmology centre in Sydney, Australia.
Results. A 79 year old Type 2 diabetic female under- went routine functional endoscopic sinus surgery where a fungal mycetoma was observed clinically and routine microbiology grew Aggregatibacter seg- nis. Three months post-procedure, the patient pre- sented with a 3 week history of gradual vision loss and constant temporal headache on the ipsilateral side. Examination revealed light perception vision, an RAPD, motility limitation, absent corneal re?ex and mild disc pallor. Imaging revealed opaciftcation of the posterior ethmoidal air cells extending through the posteromedial orbital wall to involve the orbital apex. An urgent orbital and sinonasal decompression was undertaken where microbiology grew Pseudo- monas aeruginosa with no fungus isolated. The patient was treated with liposomal amphotericin B, posaconazole and tazocin. The patient recovered with no visual sequelae.
Conclusion. Sinusitis complicated by orbital apex syndrome is rare. Pseudomonas sinusitis may be a mimicker of mucormycosis and should be consid- ered as a differential in diabetic patients.