RHINO – ORBITAL MUCORMYCOSIS
A 64 Years old female, house wife from Dinga (District Kharian) presented on 4th October, 2006 with complaint of painless drooping of left upper eye lid for the last 15 days. It was followed by pain in left upper molar tooth and painless loss of vision in left eye for last 10 days. Patient was known diabetic for the last 12 years and was on oral hypoglycaemic drugs. Vision in left eye was no perception of light and in right eye, 6/12 improving to 6/9 with glasses. There was left complete ptosis, puffiness of the upper eyelid and facial nerve paresis. On elevating the lid, there was 4 mm proptosis, inferotemporal dystopia and exotropia of 30 prism diopters. There was conjunctival congestion and total ophthalmoplegia in left eye (Fig.1). Rest of anterior segment examination in both eyes was unremarkable. Fundoscopy showed preproliferative diabetic retinopathy in both eyes and disc congestion in left eye. IOP was 14 mm of Hg in right eye and 16 mm of Hg in left eye. Blood complete picture, urine routine examination and chest radiograph - PA view were unremarkable. Blood sugar fasting was 10 mmol/L and random was 16 mmol/L. X ray paranasal sinuses followed by CT Scan showed hazy left maxillary sinus. Tissue biopsy was taken from left maxillary sinus and sent for histopathology which confirmed the diagnosis of mucormycosis. Blood glucose was controlled under supervision of medical specialist. Subtotal exentration of left orbit (sparing the eyelids) along with removal of left maxillary sinus was performed (Fig. 2). Inj. Amphotericin B, 12 mg 6 hourly IV was started. Patient recovered postoperatively but unfortunately expired on 7th postoperative day after remaining in coma for 24 hours.