Clinical manifestations and management of ocular mucormycosis during COVID-19 pandemic in Eastern India: A retrospective analysis

Purpose: To report the clinical presentation, risk factors and treatment outcomes of ocular mucormycosis during COVID-19 pandemic in Eastern India. Method: Eleven cases of biopsy-proven rhino-orbital mucormycosis with a history of concurrent or past COVID-19 presenting to the ophthalmology department of two tertiary referral centres in Eastern India from April to June 2021 were studied. Complete ophthalmological, otolaryngeal workup and imaging studies, staging was done and treatment was planned in a multidisciplinary approach. Empirical systemic amphotericin B was started. All cases underwent radical sinus surgery with orbital wall decompression, sinus and orbital irrigation with amphotericin B, followed by regular nasal debridement and serial ophthalmic examinations. Cases were followed up for a period of three months. Results: The mean age was 46.5 ± 10.7 years with male preponderance (90.9%). 90.90% of patients had elevated blood sugar levels at presentation. The common ocular presentations were conjunctival congestion (90.90%), periorbital oedema (72.72%), ophthalmoplegia (72.72%), diminution of vision (63.63%), ptosis (54.54%) and proptosis (45.45%). After treatment, regular follow-up showed clinical improvement in vision (80%), chronic ophthalmoplegia (83.3%) and complete improvement in proptosis, ptosis and periorbital oedema. COVID infection, old age, hyperglycemia, unvaccinated status and cerebral involvement were associated with increased mortality. The survival rate at three months follow-up was 81.8% and these patients were on antifungal therapy. Conclusion: A high index of suspicion and early detection as well as prompt medical and surgical treatment increases the chances of survival. Orbital wall decompression, sinus and orbital irrigation with amphotericin B are helpful in salvaging the eye and vision in most cases.