Hussain Allami, Hadeel Muhammad Alarfaj, Hisham Almousa, Razan Abdullah Aldhahri, Rayan Alfallaj, Abdulmajeed Alharbi, Sarah S Alotaibi, Ghassan Alokby, Saad Alsaleh
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All 3 patients were otherwise healthy adults in their early 20s with extensive nasal polyps on endoscopic nasal examination and bone erosion in the bilateral orbits and lateral wall of the sphenoid sinus on the affected side on imaging. One of the 3 patients had bilateral cranial nerve IV defects in addition to cranial nerve III defects. All patients underwent endoscopic sinus surgery with orbital decompression and were followed up postoperatively by both otolaryngology and ophthalmology services with endoscopic and radiologic evaluation. Unfortunately, no meaningful improvement in vision was observed in any patient despite successful nerve decompression. 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引用次数: 0
摘要
过敏性真菌性鼻炎(AFRS)是慢性非侵袭性鼻窦炎的一种亚型,占所有慢性鼻炎病例的 7.8%(0.2%-26.7%)。明确诊断通常要在鼻窦手术后进行。成功的治疗需要手术和药物治疗相结合。虽然眼眶受累相对常见,但有关视神经病变和急性视力丧失的报道却很有限。在此,我们介绍了以急性视力下降为主诉的 3 例 AFRS 患者。这 3 名患者均为 20 岁出头、身体健康的成年人,鼻内镜检查发现广泛的鼻息肉,影像学检查发现双侧眼眶和患侧蝶窦侧壁骨质侵蚀。3 名患者中的 1 人除了颅神经 III 缺损外,还伴有双侧颅神经 IV 缺损。所有患者都接受了内窥镜鼻窦手术和眼眶减压术,术后由耳鼻喉科和眼科进行随访,并进行内窥镜和放射学评估。遗憾的是,尽管成功地进行了神经减压,但所有患者的视力都没有明显改善。及时诊断、早期医疗和手术干预是预防眼眶扩展型失明(AFRS)患者并发症的必要条件。
Acute Vision Loss in Patients With Allergic Fungal Rhinosinusitis: A Case Series.
Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic noninvasive sinusitis accounting for 7.8% (0.2%-26.7%) of all chronic rhinosinusitis cases. A definitive diagnosis is usually made after sinus surgery. Successful treatment requires a combination of surgical and medical management. Although orbital involvement is relatively common, reports on optic neuropathy and acute vision loss are limited. Herein, we present a series of 3 patients with AFRS who presented with acute visual loss as the chief complaint. All 3 patients were otherwise healthy adults in their early 20s with extensive nasal polyps on endoscopic nasal examination and bone erosion in the bilateral orbits and lateral wall of the sphenoid sinus on the affected side on imaging. One of the 3 patients had bilateral cranial nerve IV defects in addition to cranial nerve III defects. All patients underwent endoscopic sinus surgery with orbital decompression and were followed up postoperatively by both otolaryngology and ophthalmology services with endoscopic and radiologic evaluation. Unfortunately, no meaningful improvement in vision was observed in any patient despite successful nerve decompression. Prompt diagnosis and early medical and surgical intervention are warranted to prevent complications in patients with AFRS with orbital extension.