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Show Journal of Nemo- Ophthalmology 17( 1): 51- 52, 1997. CO 1997 Lippincott- Ravcn Publishers, Philadelphia Evolution of Fundus Changes in Mucormycosis R. Mitchell Newman, M. D. and Lanning B. Kline, M. D. FIG. 1. At onset of illness, patient demonstrates left ptosis and proptosis. A 21- year- old insulin- dependent diabetic woman experienced left orbital pain without chills or fever. Within 48 hours, she developed left ptosis, proptosis, and complete ophthalmoplegia ( Fig. 1). Acuity Manuscript received December 14, 1995; From the Combined Program in Ophthalmology, Eye Foundation Hospital Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama. Address correspondence and reprint requests to Dr. Lanning B. Kline, 1000 South 19th Street, Birmingham, AL 35205, U. S. A. FIG. 2. Left fundus reveals optic disc and retinal edema, and venous engorgement. in the left eye was no light perception, andthc fundus revealed edema of the optic disc and peripapillary retina ( Fig. 2). Contrast- enhanced orbital computed tomography ( CT) demonstrated mild left ethmoid sinusitis. The patient underwent transnasal endoscopic exploration of the left ethmoid and maxillary sinuses, and biopsy specimens were consistent with mucormycosis ( Fig. 3). Therapy consisted FIG. 3. Biopsy from left ethmoid sinus. Left: fungal elements invading an arterial wall and causing thrombosis ( silver strain, x100). Right: magnified view demonstrates characteristic hyphae of mucormycosis ( PAS, x400). 51 52 R. MITCHELL NEWMAN AND LANNING B. KLINE FIG. 4. At 6 months after onset of illness, patient has regained most levator and extraocular muscle function on the left. of repeated endoscopic debridement of the left paranasal sinuses, coupled with local irrigation and intravenous adminis- tration of amphotericin- B. Over the ensuing 7 months, the patient regained most of the function of the levator and extraocular muscles on the left ( Fig. 4), although she remained blind in the left eye ( Figs. 5 and 6). COMMENT Rhino- orbital- cerebral mucormycosis is an acute infection caused by several fungi of the order Mu-corales ( 1). Virtually all patients with mucormycosis are either immunosuppressed or have some underlying disease including diabetes mellitus, cancer, or renal failure ( 2). Common ophthalmologic findings include orbital or facial pain, ophthalmoplegia, decreased vision, proptosis, chemosis, and corneal or periorbital anesthesia ( 2,3). Treatment consists of intravenous amphotericin- B and aggressive de- FIG. 6. Left fundus at 6 months reveals widespread chorioretinal pigmentary changes and optic atrophy. bridement of infected tissue within the paranasal sinuses, at times combined with orbital exenteration. Despite prompt therapy, mucormycosis is often fatal, with death usually due to fungi invading the brain or compromising the cerebral circulation ( 4). Unique to our case is a series of fundus photographs taken during acute infection, convalescence, and recovery. These fundus changes are consistent with previous descriptions of posterior ciliary artery occlusion leading to optic disc and choroidal infarction ( 5). REFERENCES 1. Lehrer RI, Howard DH, Sypherd PS, et al. Mucormycosis. Ann Inl Med 1980; 93: 93- 108. 2. Yohai RA, Bullock JD, Aziz AA, Markert RJ. Survival factors in rhino- orbital- cerebral mucormycosis. Surv Ophthalmol 1994; 39: 3- 22. 3. Ferry AP, Abedi S. Diagnosis and management of rhino-orbitocerebral mucormycosis ( phycomycosis) Ophthalmology 1983; 90: 1096- 104. 4. Schwartz JN, Donnelly EH, Klintworth GK. Ocular and orbital phycomycosis. Surv Ophthalmol 1977; 22: 3- 28. 5. Hayreh SS, Barnes JA. Occlusion of the posterior ciliary artery. II: chorio- retinal lesions. Br J Ophthalmol 1972; 56: 736- 53. rm. 5. Left fundus at 2 months demonstrating chorioretinal scarring and retinal exudates in the posterior pole. J Neiiro- Ophthalmol, Vol. 17, No. 1, 1997 |
