title: Acute orbital apex syndrome and rhino-orbito-cerebral mucormycosis.
abstract: OBJECTIVE
  To demonstrate the successful clinical identification and management of rhino-orbital mucormycosis, a fungal infection with a high mortality rate.
  
  
  METHODS
  A diabetic male patient with a headache and orbital apex syndrome in the right eye was examined using computed tomography (CT) and magnetic resonance imaging (MRI) for a possible fungal infection. Endoscopic surgical resection was performed and a pathology sample was taken. Specimens were prepared with Gömöri methenamine silver and hematoxylin and eosin staining. The patient was treated with liposomal amphotericin B 400 mg daily, followed by posaconazole 400 mg twice daily.
  
  
  RESULTS
  CT and MRI revealed a mass of the right sphenoid spreading into the orbit, indicative of a fungal infection. The biopsy confirmed the diagnosis of mucormycosis. Complete recovery of eyelid and oculomotor function was achieved after 10 months of treatment, although the patient continues to suffer from irreversible blindness in the right eye due to optic nerve atrophy. He has been without signs or symptoms of recurrence.
  
  
  CONCLUSIONS
  Patients with rhino-orbito-cerebral mucormycosis need extensive surgical and medical treatment to maximize outcomes. Success requires multidisciplinary management.
authors.affiliation: Research Center, Martel Eye Medical Group, Rancho Cordova, CA, USA.
authors.forename: Ursula M
authors.initials: UM
authors.lastname: Anders
authors.affiliation: Research Center, Martel Eye Medical Group, Rancho Cordova, CA, USA.
authors.forename: Elise J
authors.initials: EJ
authors.lastname: Taylor
authors.affiliation: Research Center, Martel Eye Medical Group, Rancho Cordova, CA, USA ; Graduate Medical Education, California Northstate University College of Medicine, Elk Grove, CA, USA ; Department of Ophthalmology, Dignity Health, Carmichael, CA, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Martel
authors.affiliation: Research Center, Martel Eye Medical Group, Rancho Cordova, CA, USA ; Graduate Medical Education, California Northstate University College of Medicine, Elk Grove, CA, USA ; Department of Ophthalmology, Dignity Health, Carmichael, CA, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Martel
keywords: amphotericin B; diabetes mellitus; nephrotoxicity; ophthalmoplegia; posaconazole; sixth nerve palsy