Sino-orbital aspergillosis associated with total ophthalmoplegia

Invasive aspergillosis of the paranasal sinuses involving the orbit is termed sino-orbital aspergillosis. Prognosis of sino-orbital aspergillosis, complicated by impaired visual acuity and neurological signs, is disastrous and usually fatal. We herein report two patients with sino-orbital aspergillosis associated with total ophthalmoplegia. One patient was successfully treated with surgical eradication including orbital exenteration. In contrast, the other died of cerebral infarction, probably due to fungal thrombosis of the middle cerebral artery, despite repeated local debridement followed by orbital exenteration and administration of antifungal agents. Experience with these cases strongly indicates the necessity of prompt surgical eradication, including orbital exenteration if necessary, in the treatment of sino-orbital aspergillosis.