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KMID : 1191420090080010015
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Korean Journal of Optometry and Vision Science
2009 Volume.8 No. 1 p.15 ~ p.19
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A Case of Rhino-Orbito-Cerebral Mucormycosis with Bilateral Ophthalmic Artery Occlusion
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Roh Joon-Ho
Nam Dong-Heun
Chi Mi-Jung
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Abstract
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Purpose: To describe a case of rhino-orbito-cerebral mucormycosis with bilateral ophthalmic artery occlusion.
Methods: A 70 year old woman who was diagnosed as diabetes mellitus at 15 years ago was referred to ophthalmologist for headache, visual disturbance, and periorbital swelling of right eye. On examination, there were dilation of pupil, complete ophthalmoplegia, severe corneal edema, and retinal whitening in right eye. She was observed with administration of systemic antibiotics, but same symptoms including decreased visual acuity as right eye happened to left eye. On fundus examination of left eye, there were a cherry red spot and ghost arteries that showed the absence of arterial blood flow. Fluorescein angiography showed the delayed and remarkably decreased choroidal perfusion and the retinal arterial filling defect that was maintained till late phase in left eye although it showed the obscure image because of severe corneal edemea in right eye.
Results: At 3rd days of therapy, cavernous sinus thrombosis in magnetic resonance image and black eschar in face were observed. Based on ischemic signs of anterior and posterior segment in both eyes, clinical course and typical skin lesion, we suspected rhino-orbito-cerebral mucormycosis with bilateral ophthalmic artery occlusion and planned biopsy of paranasal sinus, exenteration with intravenous administration of amphotericin B, but her family refused the operation. Then, the patient was dead at 4th days of therapy.
Conclusions: Rapidly progressive ischemic changes can occur in bilateral ophthalmic artery occlusion accompanying with rhino-orbito-cerebral mucormycosis.
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KEYWORD
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Anterior segment ischemia, Bilateral ophthalmic artery occlusion, Mucormycosis
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