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Orbital apex syndrome as a result of invasive fungal sinusitis is a disease entity most commonly found in immunocompromised patients. Infectious invasion affecting the orbital apex can have devastating visual and life-threatening consequences. Mucormycosis and Aspergillus species are the most common causes of such infections. Alternaria fungal sinusitis is a known entity, but its ability to cause an orbital apex syndrome has not yet been reported. Here, we present a case of orbital apex syndrome in an immunocompromised patient with invasive fungal sinusitis caused by Alternaria species. The patient underwent sinus washout and placement of an intraorbital catheter for local instillation of amphotericin B for 10 days, in addition to systemic antifungal treatment, with clinical resolution of infection. The use of an intraorbital catheter for local treatment of fungal infection may offer an exenteration-sparing treatment option in these patients.

Objective: To report a case of fungal keratitis caused by Alternaria in a 49-year-old female who developed an acute onset of eye infection after ocular trauma caused by an olive leaf., Methods: The clinical presentation, microbiological diagnosis, and therapeutic approaches are reported., Results: The patient was referred to our university hospital clinic with corneal abscess in her left eye. Before the start of an empirical antibacterial therapy (both topical and systemic), a swab of the cornea was obtained which at microscopic examination revealed a few fragments of hyphal elements, probably for the paucity of material collected. After one week, the corneal abscess had increased in size, and the corneal stroma was filled with filamentous structures similar to fungal hyphae. Oral and topical voriconazole was administered because of the clinical picture and the response of microbiological laboratory whose examination of the material removed from the anterior chamber showed numerous hyphal fragments identified by culture as Alternaria spp. The corneal abscess healed in two weeks, but the patient now has a corneal scar and is awaiting a corneal transplant., Conclusions: Ophthalmologists and microbiologists must take fungi into greater consideration as a possible cause of keratitis as they are emerging as the cause of this infectious disease in many countries. Voriconazole spreads well in the eye and is effective in the cure of fungal keratitis including those caused by Alternaria.

Objective: To report a case of scleral buckle infection by Alternaria fungus., Case Report: A 75-year-old male who underwent rhegmatogenous retinal detachment repair 11 years ago developed a scleral buckle infection during the course of serial injections of bevacizumab for the treatment of wet age-related macular degeneration. Removal of the scleral buckle was done and culture results revealed Alternaria species., Results: The infected scleral buckle was removed and the patient received oral voriconazole. The patient's best corrected visual acuity changed from 20/50 preoperatively to 20/150 six months after the procedure., Conclusion: Alternaria species may be encountered as a cause of scleral buckle infection.