Abstract
Ocular ischaemic syndrome (OIS) is a relatively uncommon condition. Simultaneous bilateral involvement is even less common and has been reported in only 22% of all cases of OIS. It has variable clinical presentations, of which visual loss and ocular pain are the most common. It is believed to occur when there is a 90% or greater carotid artery obstruction. This syndrome is often associated with a number of systemic diseases including diabetes mellitus, hypertension, coronary artery disease, and cerebrovascular disease. Only occasionally has it been described as a complication of rhinocerebral mucormycosis. We report an unusual case of bilateral OIS secondary to bilateral internal carotid artery thrombosis as a complication of invasive rhinocerebral mucormycosis. In addition, a review of clinical presentation, diagnostic work-up and treatment options for OIS is provided.
Highlights
Ocular ischaemic syndrome (OIS) is a relatively uncommon condition
Bilateral Ocular Ischaemic Syndrome—Rare Complication of Rhinocerebral Mucormycosis in an Omani Patient Case report and literature review the organism spreads along the meninges, nerves, and vessels
In this article we report a case of rhinocerebral mucormycosis with no evidence of direct spread through the orbit
Summary
In January 2010, a 57-year-old Omani woman who was a known diabetic and had been receiving treatment for hypertension for many years developed right cavernous sinus thrombosis. Amphotericin was substituted for caspofungin and posaconazole due to renal failure During one of her recent admissions for another sinus debridement surgery, she complained of bilateral sudden visual loss associated with right eye pain. Implantation, bilateral non-proliferative diabetic retinopathy, and diabetic macular oedema Her right eye was treated with a focal laser. An anterior segment examination for both eyes (OU) was unremarkable except for middilated poorly reactive pupils and pseudophakia Her intraocular pressure (IOP) OU was normal. A MRI angiogram showed complete absence of flow in the ICAs [Figures 3a and b] This was confirmed by conventional digital subtraction angiography (DSA) of the ICAs as well as by cerebral angiography, which revealed bilateral abrupt occlusion of the internal carotid arteries. In April 2012, she was still attending hospital follow-up visits to monitor her rhinocerebral mucormycosis for which oral posaconazole was prescribed
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