Rhino-Orbital Mucormycosis Presenting As Orbital Apex Syndrome With Central Retinal Artery Occlusion: A Rare Phenomenon

Rhino-orbital-cerebral mucormycosis (ROCM) is an opportunistic infection that has increased due to COVID-19 with the use of corticosteroids and diabetes being the most important predisposing factors. Orbital apex syndrome with central retinal artery occlusion secondary to mucormycosis is relatively rare. This case report highlights a case of a 62-year-old female with poorly controlled diabetes and a history of COVID-19 two weeks prior, who presented with acute right eye painful visual loss for three days associated with bulging of the right eye and drooping of the eyelid. On presentation, she had no light perception in her right eye, total ocular movement restriction, lid swelling, bulging of the eye, and complete ptosis. Examination of the right eye showed mild conjunctival redness with evidence of central retinal artery occlusion. Contrast-enhanced computed tomography of the brain and orbit revealed evidence of orbital cellulitis with sinusitis. Nasal endoscopy revealed features of fungal sinusitis. Despite multiple attempts of debridement and intravenous Amphotericin B, the patient's condition progressed and required right orbital exenteration. This report aims to highlight the necessity of high suspicion of ROCM in COVID-19 patients with diabetes, a history of steroid use, and the need to be followed up beyond recovery. Multidisciplinary team management is needed to detect red flag symptoms and signs, diagnose promptly with appropriate microbiological and radiological investigations, and initiate early treatment with antifungal and aggressive surgical debridement for a successful outcome and to prevent the need for extensive surgical measures like orbital exenteration.