Invasive mucormycosis of superior orbital fissure: A multidiscipilary approach

Abstract

Invasive fungal sinusitis is a potentially life-threatening condition, particularly in immuno-compromised individuals. Extension into the orbit, especially involving the Superior Orbital Fissure (SOF), is rare but not uncommon due to the proximity of essential neurovascular structures which facilitate the anterograde spread of infection. We report a case of a 45-year-old diabetic and hypertensive female who presented with acute onset facial pain, proptosis, ophthalmoplegia and visual impairment in both eyes. An MRI of the brain revealed an acute embolic infarct in the left occipital region and multiple lacunar infarcts, consistent with invasive fungal sinusitis of the right maxillary sinus. Histopathological examination confirmed mucormycosis. A multidisciplinary team including otorhinolaryngology, ophthalmology, radiology, and internal medicine was promptly involved. The patient underwent urgent micro debridement-assisted Functional Endoscopic Sinus Surgery (FESS) with orbital decompression and was started on intravenous liposomal amphotericin B. Metabolic optimization and close ophthalmologic monitoring were integral to the management. The patient showed significant clinical improvement. Resolution of orbital symptoms and preservation of vision, highlighting the importance of coordinated, timely, and comprehensive care.