Orbital apex syndrome in noninvasive fungal rhinosinusitis: a case report.

Noninvasive fungal rhinosinusitis is the most common type of fungal sinusitis, but it rarely leads to orbital apex syndrome. In this case study, we present a 44-year-old female who developed headache and sudden loss of vision in the left eye. Examination revealed ptosis, complete visual loss, and total ophthalmoplegia in the left eye. Imaging showed a fully opacified mass in the left orbital apex and spheno-ethmoidal recess, involving the adjacent ophthalmic artery, optic nerve, and extraocular muscles. The patient was diagnosed with orbital apex syndrome secondary to noninvasive fungal rhinosinusitis. She received a 3-day course of methylprednisolone without improvement, followed by functional endoscopic sinus surgery. Histopathology confirmed a fungal ball (aspergilloma) without tissue invasion. The patient was hospitalized for 2 weeks, treated with perioperative antibiotics, but did not receive systemic antifungal therapy. At 3 months follow-up, headache, proptosis, and pain had resolved, but vision loss and ptosis did not improve significantly. Early recognition and timely surgical intervention are crucial in preventing irreversible complications of noninvasive fungal rhinosinusitis.