Abstract text (incl. figure legends and references)

We present the case of a previously healthy 53 year old man who presented in the emergency department with drooping of the upper eyelid and difficulty seeing clearly. These symptoms started 5 days ago. The patient has diabetes type 2 and was started on steroids because he was diagnosed with COVID 2 weeks before.

On examination there was proptosis of the right eye, the pupil was not reactive to light and there was ophthalmoplegia of 3rd and 6th cranial nerves. The patient also feels paresthesias and a neuralgic pain in the V1 and V2 territory. On visual testing he can only see shadows with the right eye. The rest of the physical exam was normal.

On blood work, except for a HbA1C at 9.5 % and HSV1 IgG (+) and VZV IgG (+), other results were within the normal range. The imaging studies revealed no vascular lesions on CT angiography and brain MRI showed retroorbital inflammation on the right side, no signal restriction and the venous system appeared normal, ruling out venous sinus thrombosis.

Tissue biopsy confirmed the diagnosis of mucormycosis and treatment with Amphotericin B for 5 days followed by fluconazole. The inflammation seemed to subside, the patient still had some limitations in eye movement and the vision got better but he developed neuralgic pain that was stabbing in character in the V1 and V2 territories. We discharged the patient and started outpatient Carbamazepine therapy for a month which was unsuccessful and then switched to Pregabaline 150 mg/daily. We followed up in 3 months and then in 6 months and the patient is doing better and Pregabalin was slowly tapered.