Analytical study of Clinical Presentation and Diagnosis Importance in Outcome of Orbital Muccormycosis in Diabetes Mellitus

INTRODUCTION: The two orbits are quadrangular truncated pyramids that contain the globe, extra ocular muscles, nerves, fat and blood vessels. The walls of both the orbits are in close relation with paranasal air sinuses namely ethmoidal sinuses, maxillary sinuses, sphenoidal sinuses and frontal sinuses. The orbit is also in close relation to cranial fossa (anterior and middle) and temporal fossa. Therefore infections from these related structures spread easily to the orbit. Mucormycosis refers to the group of uncommon, aggressive & fatal angioinvasive infections caused by filamentous fungi of Mucoraceae family. It is usually seen in immunocompromised patients and uncontrolled Diabetes mellitus is a common predisposing factor. Rhino-orbital-cerebral mucormycosis is the commonest presentation. Visual loss & ophthalmoplegia are common ophthalmic manifestations of Rhino-orbital-cerebral mucormycosis. Management includes intensive antifungal therapy followed by appropriate surgery & adjunctive therapy. Due to residual morbidity & high mortality rates of mucormycosis, early clinical diagnosis could be effective in its favorable management. OBJECTIVES OF THE STUDY: 1. To analyse the various clinical presentation of orbital mucornycosis in diabetes mellitus 2. To establish the importance of preventing case fatality and reducing ocular morbidity through early diagnosis and prompt management. STUDY DESIGN: Prospective non comparative interventional analytical cohort study. METHODOLOGY: Patients with the age group more than 40 years presenting to OP, Department of Ophthalmology, RIOGOH with orbital mucormycosis are taken for this study after obtaining consent. In this study 30 patients were evaluated. Proper history, orbital & ocular examination, SLE, Opthalmoscopy, visual acuity, colour vision, IOP, Diplopia charting, B Scan, CT, MRI, Tissue biopsy and orbital FNAC done. RESULTS: Most patients in our study were males and majority of patients were in the age group of 50-55. Main ocular manifestation in the study was painful proptosis and pre septal cellulitis is the commonest orbital presentation. Patients also presented with cranial nerve palsy and multiple nerve palsy was common. Bilateral ocular involvement was common in the study group but it was asymmetrical. Maxillary sinus is commonly involved and increased mucosal thickening was the commonest radiological finding in our study group. Patients who have blood sugar level of 251-300mg/dl and duration of diabetes between 11-15 years are the one who have the clinical evidence of orbital mucormycosis. CONCLUSION Rhino- Orbital mucormycosis is a rare but fatal filamentous fungal infection of orbit. Infection is commonly seen in patients with uncontrolled diabetes. Visual loss and ophthalmoplegia is the common ophthalmic manifestation. Management includes intensive antifungal therapy followed by appropriate surgery and adjunctive therapy. Residual morbidity and high mortality occurs if clinical diagnosis is delayed