Visual Function Loss in Fungal Sphenoid Sinusitis: Clinical Characteristics and Outcomes

Potentially fatal fungal sphenoid sinusitis (FSS) causes visual damage. However, few studies have reported on its visual impairment and prognosis. Five hundred and eleven FSS patients with visual disturbance treated at Beijing Tongren Hospital were recruited and clinical features and visual outcomes were determined. Thirty-two of the 511 patients (6%) had visual disturbance, with 13 and 19 patients having invasive and noninvasive FSS, respectively. Twenty patients (62.5%) had immunosuppression, of whom 18(56.25%) had diabetes. All patients had visual impairment, which was more severe in invasive FSS than that in noninvasive FSS. Bony wall defects and sclerosis were observed in 19 patients (59.38%), and 11 patients (34.38%) had microcalcification in their sphenoid sinusitis on computed tomography (CT). After a 5-year follow-up period, three patients (9.38%) died. Patients with noninvasive FSS had a higher improvement rate in visual acuity than their counterparts. In the multivariate analysis, sphenoid sinus wall sclerosis on CT was associated with better visual prognosis. FSS could cause vision loss with persistent headaches in immunocompromised patients, particularly those with diabetes. CT showed the sphenoid sinus wall sclerosis, indicating a better visual prognosis in FSS with visual disturbance.