Orbital Apex Syndrome in Noninvasive Fungal Rhinosinusitis: a case report

Orbital Apex Syndrome in Noninvasive Fungal Rhinosinusitis: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Orbital Apex Syndrome in Noninvasive Fungal Rhinosinusitis: a case report Zhongju Yin, Xiaoyan Hu, Shuang Liu, liang jiang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5727056/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Orbital apex syndrome (OAS) is characterized by multiple cranial nerve involvement leading to orbital pain or headache, vision loss, and ptosis. Typical clinical features are attributed to various tumors, vascular, infection, or sinus inflammatory diseases involving the orbital apex. Therefore, understanding the etiology of orbital tip syndrome and early identification and rapid treatment may help reduce related comorbidities. Case presentation We report the case of a 44-year-old Chinese female patient who presented with occipital headache, pain in the left eye, and sudden loss of vision in the left eye. Left orbital apex syndrome was diagnosed. The pain and ptosis worsened after glucocorticoid anti-inflammatory therapy and insulin control of blood glucose. CT scan was completed to consider the mass of the left sphenoid sinus, orbital apex, nasopharynx, and pterygopalatine fossa without excluding the possibility of tumor. In terms of treatment, functional endoscopic sinus surgery was performed. Headache, ptosis and pain disappeared at the latest follow-up 3 months after surgery, but left vision and ptosis did not improve significantly. Conlusion In showing the specific diagnosis and treatment process of this case, we should strengthen interdisciplinary knowledge and cooperation to prevent misdiagnosis. Early identification and prompt treatment of the cause of the orbital tip syndrome. Orbital Apex Syndrome Noninvasive Fungal Rhinosinusitis Fungal Rhinosinusitis vision loss Functional endoscopic sinus surgery Figures Figure 1 Figure 2 Background Fungal Rhinosinusitis (FRS) is a common specific infectious disease in rhinology. Due to the inappropriate use of antibiotics, glucocorticoids, and immunosuppressants, the incidence of FRS has increased in recent years. FRS can be classified into invasive fungal rhinosinusitis (IFRS) and noninvasive fungal rhinosinusitis (NIFRS). IFRS, because of its invasive properties on the mucosa and bone, can spread along blood vessels or nerves to surrounding structures and tissues, often causing serious complications in a short time. Compared with IFRS, NIFRS fungi are mostly confined to the sinus cavity, but with disease progression, it can still cause complications of surrounding structures and tissues, such as facial bulge, periorbital soft tissue swelling, pain, and in some cases, orbital and optic nerve vision loss and blindness. This is no less serious than IFRS. Here, we report a case of NIFRS with orbital apex syndrome in a 44-year-old Chinese female. Case presention A 44-year-old Chinese woman was admitted to the hospital with a 1-month history of headaches and a 1-week history of sudden decreased vision in the left eye. One month prior, the patient began experiencing headaches in the occiput and pain in her left eye. One week before admission, she suddenly lost vision in her left eye and developed left ophthalmoplegia. She had a history of poorly controlled diabetes mellitus. Magnetic resonance imaging (MRI) showed a fully opacified mass in the left orbital apex and spheno-ethmoidal recess, involving the adjacent left eye artery, optic nerve, and external eye muscles (shown in figure. 1A&B). The initial diagnosis considered a mass in the left orbital and sphenoid sinus, and attempts were made to relieve pain and control blood sugar, but her symptoms were never completely resolved. This prompted her referral to our hospital’s Ophthalmology Department. Upon examination, the patient had ptosis in the left eye, and her visual acuity was non-existent in the left eye, with total loss of external ocular muscle movement. Examination of the right eye revealed no abnormalities. She had an HbA1c level of 14%. A CT scan indicated a mass in the sphenoid sinus and posterior ethmoid sinus, bone absorption with a suspicious soft tissue mass involving the left orbital apex, and extension into the left pterygopalatine fossa and nasopharynx (shown in figure. 1C-E). The patient was diagnosed with left orbital apex syndrome in ophthalmology and admitted to the hospital. She was treated with glucocorticoid anti-inflammatory medication and insulin for blood glucose control. After treatment, the patient’s pain and ptosis worsened. Following consultation with the Otorhinolaryngologists, the left sphenoid sinus, orbital apex, nasopharynx, and pterygopalatine fossa mass were considered, and although the nature was unknown, there was some evidence of bone destruction on CT scan. Tumor could not be ruled out, so it was recommended to transfer her to the Otorhinolaryngology department for further treatment. Functional endoscopic sinus surgery was performed, revealing a large number of yellow-brown fungus balls occupying the entire sphenoid sinus. Frozen sections of the surgical specimen showed fungal elements. Postoperative histopathological examination of a biopsy specimen confirmed the presence of a fungal ball (aspergilloma) containing radiating septate hyphae (shown in figure. 2A,2B), and mucosal tissue was inflammatory, without fungal invasion (shown in figure. 2C). So the patient was diagnosed with NIFRS-induced orbital apex syndrome. at the latest follow-up, 3 months after surgery.The headaches,proptosis,and pain have disappeared, However, there was no significant improvement in her left vision and ptosis. Discussion In this patient, CT suggested inflammatory disease of orbital apex and sinuses. And when the progressive decline of unilateral vision and ophthalmic therapy was ineffective, our department recommended surgical decompression as soon as possible. Functional endoscopic sinus surgery was performed, revealing a large number of yellow-brown fungus balls occupying the entire sphenoid sinus, and postoperative histopathological examination confirmed mucosal tissue was inflammatory, without fungal invasion. Compared with NIFRS, because of IFRS invasive properties on the mucosa and bone, can spread along blood vessels or nerves to surrounding structures and tissues, often causing serious orbital complications[ 1 ]. NIFRS fungi are mostly confined to the sinus cavity. In this patient, Postoperative histopathological examination confirmed mucosal tissue was inflammatory, without fungal invasion, However, medial wall of the optic canal defects was visible. So the patient was diagnosed with NIFRS-induced orbital apex syndrome In the NIFRS a large number of literature confirmed that vision changes can be attributed to the factor: the sphenoid sinus proximity to the medial orbital side, the extended development of lesions in the sinus can directly compress the optic nerve and even cause central retinal artery occlusion, which then affects the vision[ 2 – 4 ]; However, no significant local compression was observed in this patient, mainly considering that the optic canal bone plate separating the optic nerve and the sphenoid sinus, fungi through optic canal defects which by congenital or inflammatory compression, resulting inflammation and edema of the orbital mucosa, further stimulating the optic nerve and leading to vision loss. In the diagnosis of NIFRS, preoperative diagnosis mainly relied on imaging diagnosis. In this case, the patient lacked typical imaging signs of fungal sinusitis: soft tissue shadows with calcification[ 5 ], CT and MRI mainly considered chronic inflammatory, which also led to delayed diagnosis and treatment; the progression of ocular symptoms was suppressed, but there was no significant improvement in her left vision and ptosis after surgery. which correlates with delay in seeking help. The surgery lacks significant benefit in patients with complete visual loss. Conclusion NIFRS with orbital apex syndrome as the primary manifestation is clinically rare and often misdiagnosed as a simple ophthalmic disease. Lack of understanding among ophthalmologists about NIFRS combined with orbital apex syndrome can lead to misdiagnosis and missed diagnoses. Strengthening interdisciplinary knowledge and collaboration through multidisciplinary consultation is crucial to prevent misdiagnosis. The occurrence of orbital apex syndrome due to fungal sinusitis requires active intervention, including early sinus CT or MRI and functional endoscopic sinus surgery as soon as possible. Abbreviations OAS Orbital apex syndrome FRS Fungal Rhinosinusitis IFRS invasive fungal rhinosinusitis NIFRS noninvasive fungal rhinosinusitis MRI Magnetic resonance imaging Declarations Ethical Approval and Consent to participate This article was approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University. We confirm that the manuscript containing any individual person’s data received consent from the patients and their families for publication. Funding This study was not supported by any sponsor or funder. References Huang, Y, Gui, L. Cavernous sinus-orbital apex aspergillus infection in a diabetic patient: A case report. MEDICINE. 2019; 98 (13): e15041. https://doi.org/10.1097/md.0000000000015041 Lu, T, Chen, XH, Dai, Y. Orbital Apex Syndrome Caused by Intraorbital Aspergillus Infection. J CRANIOFAC SURG. 2023; 34 (8): e788-e790. https://doi.org/10.1097/scs.0000000000009678 Alhussien, A, Alghulikah, A, Albaharna, H, et al. Loss of Vision Outcome for Allergic Fungal Sinusitis: Case Report and Literature Review. Therapeutic Advances in Allergy and Rhinology.2023; 14 27534030231176774. https://doi.org/10.1177/27534030231176774 Alharbi, SM, Alzarei, A, Ardi, T, et al. Orbital Complications of Extensive Allergic Fungal Rhinosinusitis: A Case Report. Cureus. 2023-05-01; 15 (5): e39555.https://doi.org/10.7759/cureus.39555 Guo TT. Zhu XR. CT imaging characteristics and clinical diagnosis of fungal sinusitis. Imaging research and medical applications. 2018;2(03):34-35. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5727056","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":398275998,"identity":"a58db031-9aed-4e82-bea7-50feea3c720f","order_by":0,"name":"Zhongju Yin","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Zhongju","middleName":"","lastName":"Yin","suffix":""},{"id":398275999,"identity":"5e6ab575-1c4c-4fda-a94c-3a0d6bf10737","order_by":1,"name":"Xiaoyan Hu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Xiaoyan","middleName":"","lastName":"Hu","suffix":""},{"id":398276000,"identity":"25ae84a9-1c6f-4b31-80a4-a44762f5c293","order_by":2,"name":"Shuang Liu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shuang","middleName":"","lastName":"Liu","suffix":""},{"id":398276001,"identity":"1053fbf2-f50f-4925-a9da-2bee47c90248","order_by":3,"name":"liang jiang","email":"data:image/png;base64,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","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"liang","middleName":"","lastName":"jiang","suffix":""}],"badges":[],"createdAt":"2024-12-28 16:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5727056/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5727056/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73317005,"identity":"49b13200-6d52-472d-8d39-f626fc489218","added_by":"auto","created_at":"2025-01-08 20:08:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":263576,"visible":true,"origin":"","legend":"\u003cp\u003eThe orbital enhanced MRI scan (A-B) illustrates the presence of an enhancing inflammatory phlegmon that extends from the left sphenoid sinus through the orbital apex and involves the extraocular muscles of the left orbit. Additionally, there is an abnormal swelling of the left optic nerve. In panel (C), the CT scan of the paranasal sinuses in the coronal view reveals a mass in the sphenoid sinus and posterior ethmoid sinus, along with bone destruction and a suspicious soft tissue mass affecting the left orbital apex. Panels (D) and (E) display the extension of the mass into the left pterygopalatine fossa and the presence of a suspicious soft tissue mass in the left nasopharynx, indicated by arrows.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5727056/v1/bd1990ced2b90ca5151c2166.png"},{"id":73317004,"identity":"f7fe4866-e294-41a4-b7bd-526cf356fee8","added_by":"auto","created_at":"2025-01-08 20:08:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":274562,"visible":true,"origin":"","legend":"\u003cp\u003e(A-B) Histopathology image of a fungal ball (aspergilloma) characterized by radiating septate hyphae and (C) chronic inflammation of the sinus mucosa (original magnification x 200).\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5727056/v1/53888ad296265e21db9a9a8e.png"},{"id":75702736,"identity":"05e22ef2-cc82-4cd7-8e20-15b76e0b97f9","added_by":"auto","created_at":"2025-02-07 09:39:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":780313,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5727056/v1/07f47d0e-d40e-49a1-a719-bd3fe9b65105.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Orbital Apex Syndrome in Noninvasive Fungal Rhinosinusitis: a case report","fulltext":[{"header":"Background","content":"\u003cp\u003eFungal Rhinosinusitis (FRS) is a common specific infectious disease in rhinology. Due to the inappropriate use of antibiotics, glucocorticoids, and immunosuppressants, the incidence of FRS has increased in recent years. FRS can be classified into invasive fungal rhinosinusitis (IFRS) and noninvasive fungal rhinosinusitis (NIFRS). IFRS, because of its invasive properties on the mucosa and bone, can spread along blood vessels or nerves to surrounding structures and tissues, often causing serious complications in a short time. Compared with IFRS, NIFRS fungi are mostly confined to the sinus cavity, but with disease progression, it can still cause complications of surrounding structures and tissues, such as facial bulge, periorbital soft tissue swelling, pain, and in some cases, orbital and optic nerve vision loss and blindness. This is no less serious than IFRS. Here, we report a case of NIFRS with orbital apex syndrome in a 44-year-old Chinese female.\u003c/p\u003e"},{"header":"Case presention","content":"\u003cp\u003eA 44-year-old Chinese woman was admitted to the hospital with a 1-month history of headaches and a 1-week history of sudden decreased vision in the left eye. One month prior, the patient began experiencing headaches in the occiput and pain in her left eye. One week before admission, she suddenly lost vision in her left eye and developed left ophthalmoplegia. She had a history of poorly controlled diabetes mellitus. Magnetic resonance imaging (MRI) showed a fully opacified mass in the left orbital apex and spheno-ethmoidal recess, involving the adjacent left eye artery, optic nerve, and external eye muscles (shown in figure. 1A\u0026amp;B). The initial diagnosis considered a mass in the left orbital and sphenoid sinus, and attempts were made to relieve pain and control blood sugar, but her symptoms were never completely resolved. This prompted her referral to our hospital\u0026rsquo;s Ophthalmology Department. Upon examination, the patient had ptosis in the left eye, and her visual acuity was non-existent in the left eye, with total loss of external ocular muscle movement. Examination of the right eye revealed no abnormalities. She had an HbA1c level of 14%. A CT scan indicated a mass in the sphenoid sinus and posterior ethmoid sinus, bone absorption with a suspicious soft tissue mass involving the left orbital apex, and extension into the left pterygopalatine fossa and nasopharynx (shown in figure. 1C-E). The patient was diagnosed with left orbital apex syndrome in ophthalmology and admitted to the hospital. She was treated with glucocorticoid anti-inflammatory medication and insulin for blood glucose control. After treatment, the patient\u0026rsquo;s pain and ptosis worsened. Following consultation with the Otorhinolaryngologists, the left sphenoid sinus, orbital apex, nasopharynx, and pterygopalatine fossa mass were considered, and although the nature was unknown, there was some evidence of bone destruction on CT scan. Tumor could not be ruled out, so it was recommended to transfer her to the Otorhinolaryngology department for further treatment. Functional endoscopic sinus surgery was performed, revealing a large number of yellow-brown fungus balls occupying the entire sphenoid sinus. Frozen sections of the surgical specimen showed fungal elements. Postoperative histopathological examination of a biopsy specimen confirmed the presence of a fungal ball (aspergilloma) containing radiating septate hyphae (shown in figure. 2A,2B), and mucosal tissue was inflammatory, without fungal invasion (shown in figure. 2C). So the patient was diagnosed with NIFRS-induced orbital apex syndrome. at the latest follow-up, 3 months after surgery.The headaches,proptosis,and pain have disappeared, However, there was no significant improvement in her left vision and ptosis.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this patient, CT suggested inflammatory disease of orbital apex and sinuses. And when the progressive decline of unilateral vision and ophthalmic therapy was ineffective, our department recommended surgical decompression as soon as possible.\u003c/p\u003e \u003cp\u003eFunctional endoscopic sinus surgery was performed, revealing a large number of yellow-brown fungus balls occupying the entire sphenoid sinus, and postoperative histopathological examination confirmed mucosal tissue was inflammatory, without fungal invasion. Compared with NIFRS, because of IFRS invasive properties on the mucosa and bone, can spread along blood vessels or nerves to surrounding structures and tissues, often causing serious orbital complications[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. NIFRS fungi are mostly confined to the sinus cavity. In this patient, Postoperative histopathological examination confirmed mucosal tissue was inflammatory, without fungal invasion, However, medial wall of the optic canal defects was visible. So the patient was diagnosed with NIFRS-induced orbital apex syndrome\u003c/p\u003e \u003cp\u003eIn the NIFRS a large number of literature confirmed that vision changes can be attributed to the factor: the sphenoid sinus proximity to the medial orbital side, the extended development of lesions in the sinus can directly compress the optic nerve and even cause central retinal artery occlusion, which then affects the vision[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]; However, no significant local compression was observed in this patient, mainly considering that the optic canal bone plate separating the optic nerve and the sphenoid sinus, fungi through optic canal defects which by congenital or inflammatory compression, resulting inflammation and edema of the orbital mucosa, further stimulating the optic nerve and leading to vision loss.\u003c/p\u003e \u003cp\u003eIn the diagnosis of NIFRS, preoperative diagnosis mainly relied on imaging diagnosis. In this case, the patient lacked typical imaging signs of fungal sinusitis: soft tissue shadows with calcification[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], CT and MRI mainly considered chronic inflammatory, which also led to delayed diagnosis and treatment; the progression of ocular symptoms was suppressed, but there was no significant improvement in her left vision and ptosis after surgery. which correlates with delay in seeking help. The surgery lacks significant benefit in patients with complete visual loss.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eNIFRS with orbital apex syndrome as the primary manifestation is clinically rare and often misdiagnosed as a simple ophthalmic disease. Lack of understanding among ophthalmologists about NIFRS combined with orbital apex syndrome can lead to misdiagnosis and missed diagnoses. Strengthening interdisciplinary knowledge and collaboration through multidisciplinary consultation is crucial to prevent misdiagnosis. The occurrence of orbital apex syndrome due to fungal sinusitis requires active intervention, including early sinus CT or MRI and functional endoscopic sinus surgery as soon as possible.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eOAS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Orbital apex syndrome\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFRS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Fungal Rhinosinusitis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIFRS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;invasive fungal rhinosinusitis\u003c/p\u003e\n\u003cp\u003eNIFRS \u0026nbsp; \u0026nbsp; \u0026nbsp; noninvasive fungal rhinosinusitis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMRI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Magnetic resonance imaging\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article was approved by the Ethics Committee of the Affiliated Hospital of Southwest Medical University. We confirm that the manuscript containing any individual person\u0026rsquo;s data received consent from the patients and their families for publication.\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not supported by any sponsor or funder.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHuang, Y, Gui, L. Cavernous sinus-orbital apex aspergillus infection in a diabetic patient: A case report. MEDICINE. 2019; 98 (13): e15041. https://doi.org/10.1097/md.0000000000015041\u003c/li\u003e\n\u003cli\u003eLu, T, Chen, XH, Dai, Y. Orbital Apex Syndrome Caused by Intraorbital Aspergillus Infection. J CRANIOFAC SURG. 2023; 34 (8): e788-e790. https://doi.org/10.1097/scs.0000000000009678\u003c/li\u003e\n\u003cli\u003eAlhussien, A, Alghulikah, A, Albaharna, H, et al. Loss of Vision Outcome for Allergic Fungal Sinusitis: Case Report and Literature Review. Therapeutic Advances in Allergy and Rhinology.2023; 14 27534030231176774. https://doi.org/10.1177/27534030231176774\u003c/li\u003e\n\u003cli\u003eAlharbi, SM, Alzarei, A, Ardi, T, et al. Orbital Complications of Extensive Allergic Fungal Rhinosinusitis: A Case Report. Cureus. 2023-05-01; 15 (5): e39555.https://doi.org/10.7759/cureus.39555\u003c/li\u003e\n\u003cli\u003eGuo TT. Zhu XR. CT imaging characteristics and clinical diagnosis of fungal sinusitis. Imaging research and medical applications. 2018;2(03):34-35. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Orbital Apex Syndrome, Noninvasive Fungal Rhinosinusitis, Fungal Rhinosinusitis, vision loss, Functional endoscopic sinus surgery","lastPublishedDoi":"10.21203/rs.3.rs-5727056/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5727056/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eOrbital apex syndrome (OAS) is characterized by multiple cranial nerve involvement leading to orbital pain or headache, vision loss, and ptosis. Typical clinical features are attributed to various tumors, vascular, infection, or sinus inflammatory diseases involving the orbital apex. Therefore, understanding the etiology of orbital tip syndrome and early identification and rapid treatment may help reduce related comorbidities.\u003c/p\u003e\n\u003cp\u003eCase presentation\u003c/p\u003e\n\u003cp\u003eWe report the case of a 44-year-old Chinese female patient who presented with occipital headache, pain in the left eye, and sudden loss of vision in the left eye. Left orbital apex syndrome was diagnosed. The pain and ptosis worsened after glucocorticoid anti-inflammatory therapy and insulin control of blood glucose. CT scan was completed to consider the mass of the left sphenoid sinus, orbital apex, nasopharynx, and pterygopalatine fossa without excluding the possibility of tumor. In terms of treatment, functional endoscopic sinus surgery was performed. Headache, ptosis and pain disappeared at the latest follow-up 3 months after surgery, but left vision and ptosis did not improve significantly.\u003c/p\u003e\n\u003cp\u003eConlusion\u003c/p\u003e\n\u003cp\u003eIn showing the specific diagnosis and treatment process of this case, we should strengthen interdisciplinary knowledge and cooperation to prevent misdiagnosis. Early identification and prompt treatment of the cause of the orbital tip syndrome.\u003c/p\u003e","manuscriptTitle":"Orbital Apex Syndrome in Noninvasive Fungal Rhinosinusitis: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-08 20:08:08","doi":"10.21203/rs.3.rs-5727056/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9976c2d3-7cb0-41fa-a5af-88945308e41f","owner":[],"postedDate":"January 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-07T09:38:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-08 20:08:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5727056","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5727056","identity":"rs-5727056","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}