Orbital apex syndrome in rhino-orbito-cerebralmucormycosis (ROCM) – A prospective observational study

Abstract

Orbital apex syndrome (OAS) is an uncommon clinical presentation consisting of complete ophthalmoplegia with vision loss, involving cranial nerves II, III, IV, V, and VI. OAS may result from trauma, malignancy, infection, inflammation, or vascular origins. Aims of the study were to analyse the incidence and presentation of orbital apex syndrome in rhino-orbital mucormycosis in a tertiary care hospital. A total of 29 cases (4.1%) out of 696 cases of invasive ROCM with OAS as a presenting feature were documented. Amphotericin B in both retrobulbar and intravenous routes played a crucial role in arresting the spread of the disease allowing only 8 (27%) cases to show disease progression. FESS if done appropriately with efficient debridement of necrotic infective tissue can be a powerful tool in redirecting the course of disease for the better (only 2 of 8 patients with CST at the time of presentation had a history of FESS done prior. ROCM is a severe, emergent and fatal infection requiring multidisciplinary management. It may often present with OAS initially. Mucormycosis must be considered in such patients and timely aggressive management must be initiated to avoid disastrous morbidity and mortality.