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PHOTO ESSAY
Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 227-228

Huge Aspergillus nidus masquerading as pseudoptosis


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 Submission01-Aug-2022
Date of Acceptance27-Oct-2022
Date of Web Publication20-Jan-2023

Correspondence Address:
J Pratheeba Devi Nivean
MN Eye Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1874_22

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  Abstract 


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

How to cite this URL:
Nivean J P, Madhivanan N, Vimala, Priya S. Huge Aspergillus nidus masquerading as pseudoptosis. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:227-8. Available from: https://www.ijoreports.in/text.asp?2023/3/1/227/368185



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 Top


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 Top

1.
Cadena J, Thompson GR 3rd, Patterson TF. Aspergillosis: Epidemiology, diagnosis, and treatment. Infect Dis Clin North Am 2021;35:415-34.  Back to cited text no. 1
    
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.  Back to cited text no. 2
    
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.  Back to cited text no. 3
    
4.
Oh DJ, Liu CY, MacIntosh PW. Unusual cause of ptosis. JAMA Ophthalmol 2019;137:320-1.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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