We read with great interest the report by Geren et al1 describing 2 cases of orbital involvement associated with allergic fungal sinusitis (AFS). Allergic fungal sinusitis is believed to be an allergic reaction to aerosolized environmental fungi in an immunocompetent host with a history of atopy.1 This disease is characterized by chronic rhinosinusitis, nasal polyposis, allergic mucin, and the presence of fungal organisms.2 The results of fungal cultures, however, are often negative because of sampling difficulty.1 Orbital involvement is uncommon but can be caused by direct extension of sinus inflammation resulting in proptosis, ptosis, and diplopia.3 We found only 7 such patients described in English-language ophthalmic literature,1 the first in 1983.4 to our knowledge, none have demonstrated the presence of a subperiosteal abscess related to AFS. We would like to add a unique case of AFS with orbital involvement associated with a large subperiosteal abscess.
Meyer DR, Nagi K. Allergic Fungal Sinusitis With Subperiosteal Orbital Abscess. Arch Ophthalmol. 2005;123(9):1281-1282. doi:10.1001/archopht.123.9.1281-c