Ophthalmoplegia that is caused by spheniod sinus aspergillosis is a rare disease. We report here on two cases of sphenoid sinus aspergillosis with diplopia that occurred in a diabetic patient and an immunocompetent patients. The diabetic patient showed a more rapid progression, severer symptoms and a delayed and incomplete recovery from the neurological deficits. The other patient had milder symptoms, a slower disease course and a more rapid recovery. We suggest that immediate imaging should be performed to diagnose the cause of diplopia in those patients presenting with atypical unilateral persistent facial pain and diplopia, and especially for those patient with diabetes mellitus