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| PHOTO ESSAY |
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| Year : 2023 | Volume
: 3
| Issue : 1 | Page : 227-228 |
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Huge Aspergillus nidus masquerading as pseudoptosis
J Pratheeba Devi Nivean1, Nivean Madhivanan2, Vimala3, Shanmuga Priya4
1 Oculoplasty Consultant, MN Eye Hospital, Chennai, Tamil Nadu, India
2 Academic Director, M N Eye Hospital, Chennai, Tamil Nadu, India
3 Pathologist- Premier Labs, MN Eye Hospital, Chennai, Tamil Nadu, India
4 Resident, MN Eye Hospital, Chennai, Tamil Nadu, India
| Date of Submission | 01-Aug-2022 |
| Date of Acceptance | 27-Oct-2022 |
| Date of Web Publication | 20-Jan-2023 |
Correspondence Address:
J Pratheeba Devi Nivean
MN Eye Hospital, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_1874_22
Keywords: Aspergillus, pseudoptosis, ptosis
How to cite this article:
Nivean J P, Madhivanan N, Vimala, Priya S. Huge Aspergillus nidus masquerading as pseudoptosis. Indian J Ophthalmol Case Rep 2023;3:227-8 |
Mechanical ptosis occurs due to the pressure caused by benign or malignant mass lesions. It is not a true ptosis and other causes for pseudoptosis includes brow ptosis, hypotropia, microphthalmos, anophthalmos, phthisis bulbi, and contralateral eyelid retraction. We present a unique case where the ptosis was due to a mass lesion in the fornix that had been missed preoperatively.
A 55-year-old lady came to us with complaints of drooping of the right upper lid for the past one year. Ice pack test and fatigability test were negative. The levator action and bells phenomenon were good in both eyes. There was no obvious swelling noted in the lid that would cause ptosis [Figure 1]. Levator plication was planned and we attempted the surgery under local anesthesia. We performed an anterior approach. Skin and orbicularis were excised and levator fibers attaching to the tarsal plate was identified and dissected free from the attachments. While performing the dissection, we noticed a greyish white mass measuring 10 × 5 mm protruding from the fornix. It was excised from the forniceal attachment and sent for histopathological evaluation (HPE) [Figure 2]a. HPE was suggestive of Aspergillus bolus [Figure 2]b. The patient was immunocompetent. Ptosis was corrected well. | Figure 1: A clinical picture of the patient showing moderate ptosis in the right eye
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 | Figure 2: (a) Intraoperative picture of mass lesion. (b) Histopathology confirming Aspergillus nidus
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| Discussion | |  |
Aspergillosis refers to a spectrum of illness that is dependent on host factors and the immunological response. Non-invasive forms include allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal rhinosinusitis, whereas more invasive diseases include chronic pulmonary aspergillosis and invasive pulmonary aspergillosis. Infection occurs due to inhalation of spores.[1] Orbital aspergillosis is a rare fungal infection in immunocompetent individuals. It presents with orbital mass, eyelid swelling, ocular motility restriction, and optic nerve compression that lead to vision loss.[2]
The fungal mass was an intraoperative surprise. After the histopathological findings, we did ask for a computed tomography (CT) scan of the paranasal sinus (PNS) and orbit to look for other involvement, but the patient was lost to follow-up and hence no treatment was started.
Our case was unique as the mass was huge and there was no nidus for it to have developed. A similar case was published earlier where a contact lens was a nidus and had caused keratitis.[3] Other unusual causes of ptosis are frontal bone osseous hemangioma, cysticercosis, ocular dermoid, and amyloidosis.[4]
We present this as we encountered an intraoperative surgical surprise which could have been avoided by double eversion. Eversion of lids should be a part of ptosis evaluation before taking the patient up for surgery.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Cadena J, Thompson GR 3 rd, Patterson TF. Aspergillosis: Epidemiology, diagnosis, and treatment. Infect Dis Clin North Am 2021;35:415-34.  |
| 2. | Pushker N, Meel R, Kashyap S, Bajaj MS, Sen S. Invasive aspergillosis of orbit in immunocompetent patients: treatment and outcome. Ophthalmology 2011;118:1886-91. |
| 3. | Perry HD, Donnenfeld ED, Grossman GA, Stein M, Epstein AB. Retained aspergillus-contaminated contact lens inducing conjunctival mass and keratoconjunctivitis in an immunocompetent patient. CLAO J 1998;24:57-8. |
| 4. | Oh DJ, Liu CY, MacIntosh PW. Unusual cause of ptosis. JAMA Ophthalmol 2019;137:320-1. |
[Figure 1], [Figure 2]
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