Central Retinal Artery Occlusion as a Rare Complication of Trichoderma-Associated Acute Invasive Fungal Sinusitis

Abstract Background: Acute invasive fungal sinusitis (AIFRS) is a life-threatening infection characterized by fungal hyphen invading the nasal mucosal, blood vessels, and nerves, leading to tissue necrosis. It often complicates intracranial infection with a high mortality rate. Ocular manifestations can indicate intracranial or systemic infection. This article reports a rare case of AIFRS complicated by central retinal artery occlusion (CRAO) caused by Trichoderma infection to provide a reference for early diagnosis and treatment. Case presentation: A 45-year-old male with undiagnosed diabetes presented with left facial numbness, periodontal pain, and progressive vision loss. Initial misdiagnosis of the patient as having facial neuritis delayed anti-fungal therapy. Despite intensive care unit (ICU) admission and surgical debridement, the patient succumbed to sepsis and intracranial infection. Ophthalmic imaging confirmed CRAO, with fundus fluorescein angiography (FFA) revealing arterial occlusion. Conclusions: This case underscores the need for early recognition of AIFRS in high-risk patients and systematic ophthalmic evaluation in cases of rapid vision loss. Multidisciplinary collaboration and cautious use of corticosteroids are critical. International guidelines recommend prompt anti-fungal therapy, but thrombolysis for CRAO remains controversial in systemic fungal infections.