Korean J Ophthalmol.  2008 Mar;22(1):66-69. 10.3341/kjo.2008.22.1.66.

Bilateral Ophthalmic Artery Occlusion in Rhino-Orbito-Cerebral Mucormycosis

• Song YM
• Shin SY

• KMID: 1107495
• DOI: http://doi.org/10.3341/kjo.2008.22.1.66

Abstract

PURPOSE: To report a case of bilateral ophthalmic artery occlusion in rhino-orbito-cerebral mucormycosis. METHODS: Reviewed clinical charts, photographs, and fluorescein angiography RESULTS: An 89-year-old man with poorly controlled diabetes developed sudden bilateral ptosis, complete ophthalmoplegia of the right eye, and superior rectus palsy of the left eye. Brain and orbit magnetic resonance imaging showed midbrain infarction and mild diffuse sinusitis. On the 2nd day of hospitalization, sudden visual loss and light reflex loss developed. There were retinal whitening, absence of retinal arterial filling, and a total lack of choroidal perfusion on fluorescein angiography of the right eye. The left eye showed a cherry red spot in the retina and the absence of retinal arterial filling and partial choroidal perfusion on fluorescein angiography. On rhinologic examination, mucormyosis was noticed. Despite treatment, visual acuity and light reflex did not recover and he died 4 days after admission. CONCLUSIONS: Bilateral ophthalmic artery occlusion can occur in rhino-orbital-cerebral mucormycosis.

Keyword

Bilateral ophthalmic artery occlusion; Mucormycosis

MeSH Terms

Aged, 80 and over
Arterial Occlusive Diseases/diagnosis/*etiology
Brain Diseases/*complications/diagnosis/microbiology
Fatal Outcome
Functional Laterality
Humans
Magnetic Resonance Imaging
Male
Mucormycosis/*complications/diagnosis/microbiology
Ophthalmic Artery/*pathology
Orbital Diseases/*complications/diagnosis/microbiology
Paranasal Sinus Diseases/*complications/diagnosis/microbiology

Figure

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  Fig. 1 Brain and orbit magnetic resonance imaging (A. T2 weighted image, B. pre-enhanced T1 weighted image, C. gadolinium-enhanced T1 image) revealed no specific abnormal findings in the orbit, except mild diffuse sinusitis.

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  Fig. 2 On the day after initial presentation, his visual acuity of both eyes decreased to perception of hand motion and bilateral complete ophthlamoplegia developed. Arrows represent direction of ocular movement.

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  Fig. 3 Fundus photographs on the day after initial presentation: (Left) Right eye (Right) left eye, Both eyes show retinal whitening and optic disc edema, the left eye shows a cherry-red spot.

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  Fig. 4 Fluorescein angrography on the day after initial presentation: (Left) Right eye (Right) left eye, at late phase. The retinal vessels are not imaged at all, even 10 minutes after injecting the dye. Slight choroid fluorescence is observed in the left eye.

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  Fig. 5 Biopsy of the hard palate ulcer confirmed mucormycosis. Candida is discovered on the surface of ulcer (arrow head) and mucor is discovered in the necrotizing deep area as widely spreading spawn (arrow). (PAS stain, ×400)

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