An upper eyelid discharging fistula in allergic fungal rhinosinusitis with frontal sinus osteomyelitis: A case report and review of the literature

Allergic fungal rhinosinusitis (AFRS) is a noninvasive form of fungal sinus disease, often associated with nasal polyposis and olfactory dysfunction. Frontal sinus osteomyelitis is a rare but serious complication, involving infection of the frontal bone. Although upper eyelid fistulas can occur in severe sinus infections, they remain an uncommon manifestation in AFRS and frontal sinus osteomyelitis. We report the case of a 52-year-old female presenting with purulent discharge from the lateral upper left eyelid, just below the supraorbital margin, due to a fistula associated with AFRS and frontal sinus osteomyelitis. Contrast-enhanced computed tomography revealed bilateral sinus mucosal inflammation and bony erosion of the left frontal sinus floor and the left orbital roof. A multidisciplinary approach, involving ophthalmologists and Ear, Nose and Throat (ENT) specialists, led to successful management.