Intraconal amphotericin B for the treatment of rhino-orbital mucormycosis.

Rhino-orbital-cerebral mucormycosis is a disease that is frequently fatal. A 39-year-old man with diabetic ketoacidosis was referred to the authors' ophthalmic service with fever, orbital apex syndrome in the right eye, lethargy, and a black eschar in the palate. He was treated with systemic and local (intraconal) amphotericin B and his ketoacidosis was controlled; exenteration was not performed. Biopsy of the palate proved mucormycosis. Eighteen months later the patient was still alive and had a blind, anatomically preserved right eye with ptosis and intact extraocular muscle function without proptosis or pain. The authors propose this alternative means of treatment to achieve higher doses of the drug at the site of infection and better cosmetic and psychological results.