Orbital Apex Syndrome in Pseudomonas Sinusitis After Functional Endoscopic Sinus Surgery

Sinusitis complicated by orbital apex syndrome is rare. The majority of cases are due to mucormycosis in immunocompromised patients. The authors report a case of orbital apex syndrome secondary to Pseudomonas sinusitis. The patient was a 79-year-old Type 2 diabetic woman who underwent left-sided functional endoscopic sinus surgery. Three months postprocedure, she presented with a 3-week history of gradual vision loss and constant temporal headache on the ipsilateral side. Examination revealed light perception vision, a relative afferent pupillary defect, absent corneal reflex, and disc pallor. Imaging revealed opacification of the posterior ethmoidal air cells extending to involve the orbital apex. Urgent orbital and sinonasal decompression was performed. Intraoperative specimens grew Pseudomonas aeruginosa. The patient was treated with liposomal amphotericin B, posaconazole, and piperacillin/tazobactam. The patient recovered with no visual sequelae. Pseudomonas is an important mimicker to consider in sinusitis causing orbital apex syndrome, and it may occur following functional endoscopic sinus surgery. Accepted for publication June 22, 2018. The authors have no financial or conflicts of interest to disclose. Portions of this work were presented, in abstract form, at the Annual Scientific Congress of the Royal Australian and New Zealand College of Ophthalmologists on October 28–November 1, 2017 in Perth, Australia. Address correspondence and reprint requests to Vannessa Leung, B.Med., M.D., Royal North Shore Hospital, Reserve Rd St Leonards, NSW 2065, Australia. E-mail: vannessa.leung@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.