J Korean Ophthalmol Soc > Volume 55(3); 2014 > Article
Journal of the Korean Ophthalmological Society 2014;55(3):426-431.
DOI: https://doi.org/10.3341/jkos.2014.55.3.426    Published online March 15, 2014.
A Case of Optic Neuropathy Caused by Fungal Ball in an Onodi Cell.
Young Soo Han, Chan Min Yang, Jae Ho Shin, In Ki Park
1Department of Ophthalmology, KyungHee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea. ikpark@medigate.net
2Department of Ophthalmology, KyungHee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
오노디 세포내 곰팡이 덩이에 의한 시신경병증 1예
한영수1⋅양찬민1⋅신재호2⋅박인기1
Department of Ophthalmology, KyungHee University Hospital, Kyung Hee University School of Medicine1, Seoul, Korea
Department of Ophthalmology, KyungHee University Hospital at Gangdong, Kyung Hee University School of Medicine2, Seoul, Korea
Abstract
PURPOSE
To report a rare case of optic neuropathy caused by a fungal ball in an Onodi cell. CASE SUMMARY: A 63-year-old female was referred to our clinic with relapsed visual loss and ocular pain in the right eye. She had been diagnosed as optic neuritis 14 days before and given pulse steroid therapy. She recovered to normal but relapsed 7 days before. In medical referral there was no suspected multiple sclerosis but only a few inflammation in the paranasal sinuses. On our initial examination, best corrected visual acuity was counting finger at 10 cm in the right eye, and 1.0 in the left eye, along with relative afferent pupillary defect in the right eye. The fundoscopic examinations disclosed disc swelling; nearly total visual field defect was observed on visual field examination and visual evoked potential test revealed decreased amplitude at P100 wave in the right eye. Clinical impression was relapsed optic neuritis. After the administration of pulse steroid therapy, her disc swelling was decreased and visual acuity was recovered to 0.6, however, visual acuity was exacerbated to 0.4 in 2 weeks. We checked outside brain magnetic resonance imaging (MRI) and the result showed optic neuropathy caused by a fungal ball in an Onodi cell. The patient was referred to otorhinolaryngologist and fungal ball was removed by endoscopic sinus surgery. 3 weeks after surgery the patient's visual acuity was 0.9, no disc swelling was found and visual evoked potential was recovered to normal. CONCLUSIONS: An Onodi cell lesion should be considered in the differential diagnosis of optic neuritis, identified by imaging studies and promptly removed by surgery for visual recovery.
Key Words: Fungal ball;Fungal sinusitis;Onodi cell;Optic neuropathy


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