Covid and

The Eye…👁. Save The Sight….

Now a days we all are familiar with this new term
MUCORMYCOSIS esp in post covid patients.
Being an Eye Specialist i am dealing with this new Ear Nose n Eye infection routinely.
This write up is just to highlight the basics of this infection.
Mucormycosis is a Fungal infection caused by Mucor fungi. Various theories have been put forward for the cause justification esp after Covid. Immunosuppression, Diabetic Ketoacidosis, Serum Iron level, excess IV vit C, excess iv steroids etc n many more. But still nothing has been pin pointed as the route cause..
This post covid Mucormycosis can be noticed at any stage very early just first week of covid n late even after one month.
But usually I noticed it two weeks post covid.

The common SYMPTOMS n my OPD are
Lid swelling
Sticky Discharge
Ptosis means closing of eyelids
Proptosis means Protruding eyeballs
Eye pain
Vision loss moderate to complete blindness.
It’s usually Unilateral.
Other symptoms Breathing difficulties, jaw pain, swelling, Bleeding nose n gums.
Here I am more focusing on eye related issues.

SPREAD n Stages of Infection

1. Sinus ethmoid followed by maxillary n Nose involvement
Sinuses act as a humidifier providing favourable environment for virus to multiply.
2.Ocular involvement
3.Cerebral involvement causing Unconsioussness, Paralysis, life threatening complications.

As far as TREATMENT is concerned, if detected early No doubt the prognosis is good. Nasal endoscopy is advised.
If not so when Ocular involvement occurs initially if Cornea is involved Topical Amphoterecin B ,Natamycin have role n this stage. Vision can be restored. Many a times patient comes very early no corneal involvement but moderate eye pain. At this stage we prescribe topical Antifungal as prophylactic treatment but if ORBITAL APEX is involved then visual prognosis is worst .

Patient doesn’t have light perception. Slowly medial orbital wall gets involved with Bony erosions.
At this stage Exenteration or ENUCLEATION is the only Option left.
Enucleation means removal of entire globe with preservation of surrounding periorbital tissues if not necrosed. Orbital Neuritis, Cellulitis , Central retinal Artery Occlusion, do not respond to topical Antifungal.
Systemic Antifungal Amphoterecin B also have very limited role.

Here Conservative Treatment does not have much role n if treated conservatively constant watch is needed to avoid corneal and anterior tissue necrosis, which usually occurs within a week.
So surgical debridement is the only treating modality.
After this Enucleation also there is a threat of depositions in the socket, here topical Antifungal plays major role. So sincere request to patient please put the prescribed drops in that empty ocular socket.
This Enucleation is a major trauma to Patient as well as to the treating Eye surgeon who usually gives Gift Of Sight to patient.
So whenever any mentioned symptoms noticed do not hesitate to rush to concerned Doctor. We are trying best not only to save your Vision but your Life too.

Still some questions are remained unanswered
Why this Mucormycosis is after 2 nd wave? What About first wave?
Why only Mucor not Aspergill?
Research going on. These are all my views n observations.

If you have any more information kindly share, which help to treat the patient better.