Lung cancer, proptosis, and decreased vision

A 48-year-old man presented to the emergency department with a 3-day histor y of decreased vision in a painful proptotic right eye. The patient was bei ng treated with chemotherapy and radiation for non-small cell lung carcinom a. Examination showed visual acuity of hand motions, decreased motility, an d an afferent pupillary defect on the right, consistent with an orbital ape x syndrome. Neuroimaging revealed "dirty" orbital fat and no paranasal sinu s disease. Orbital biopsy initially showed only fibrosis; however, on subse quent biopsies, nonseptate hyphae later identified as mucormycosis was reco vered. The patient survived with exenteration and systemic amphotericin B. (Surv Ophthalmol 43:405-412, 1999) (C) 1999 by Elsevier Science Inc. All ri ghts reserved.