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Presentation type	E-poster
Title	Unilateral Epiphora as the Presenting Sign of a Maxillary Sinus Fungus Ball

Purpose	To describe a case of a maxillary sinus fungus ball presenting to the ophthalmologist as unilateral epiphora.
Methods	68-year-old female presenting with progressive left-sided epiphora and nasal obstruction over several months.
Results	We report a 68-year-old female, followed for glaucoma, who developed left-sided epiphora and chronic nasal obstruction over several months. Lacrimal irrigation was patent, excluding canalicular or nasolacrimal duct stenosis. Nasal endoscopy revealed a non-glistening mass filling the left middle and inferior meatus up to the septum, with bulging of the medial maxillary sinus wall and no passage towards the nasopharynx. Cone-beam CT showed complete opacification of the left maxillary sinus with polypoid extension into the nasal cavity containing linear calcifications, with demineralization of the lamina papyracea and distal nasolacrimal duct, without orbital or intracranial extension. As an underlying tumor could not be excluded, biopsies were taken: pathology showed fibrous inflammatory tissue without malignancy. MRI demonstrated a 40x32x39 mm mass without contrast enhancement, favouring a fungus ball over inverted papilloma or carcinoma. After multidisciplinary oncological consultation, endoscopic sinus surgery was performed, evacuating purulent secretions and fungal concrements. One week postoperatively nasal patency was restored.
Conclusion	Fungus balls are non-invasive fungal colonisations of an obstructed sinus, typically presenting with nasal rather than ocular complaints. This case illustrates that epiphora may be the presenting sign, caused by mass effect on the nasolacrimal duct rather than intrinsic lacrimal stenosis. Imaging alone cannot reliably exclude malignancy.
Conflict of interest	No

Authors 1

Last name	RENARD
Initials	N
Department	AZ Sint-Jan
City	Brugge

Authors 2

Last name	VANDELANOTTE
Initials	S
Department	AZ Sint-Jan
City	Brugge

Authors 3

Last name	VAN DE VEIRE
Initials	S
Department	AZ Sint-Jan
City	Brugge