Neurotrophic Keratitis in Locally Advanced Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is a locally invasive malignant tumor that invades the orbit frequently. We came across a 65-year-old man with locally advanced nasopharyngeal carcinoma on chemotherapy with orbital invasion causing total ophthalmoplegia, loss of corneal sensations, and ptosis. He also had a central neurotrophic keratitis with hypopyon. Based on these findings, a diagnosis of left-sided superior orbital fissure syndrome with neurotrophic keratitis was made. CT scan of the head revealed a soft-tissue mass abutting the superior aspect of the orbit and cavernous sinus and tumor recurrence was confirmed. We started the patient on topical fortified antibiotics and Atropine after placing a bandage contact lens. He was advised palliative radiotherapy by the medical oncologist. In two months, there was marked improvement in ocular motility, ptosis, and redness. The ulcer had healed by the formation of a central macular opacity. Corneal sensations had returned. This case exemplifies the reversible nature of superior orbital fissure syndrome and associated corneal anesthesia. As the tumor is radiosensitive, the mass effect of the tumor was reduced leading to the resolution of ophthalmoplegia and healing of the ulcer.