Shabari Pal

Abstract

Introduction: Fungal infections of the orbit have been recognized as one of the most critical infective lesions in the field of ophthalmology due to its morbidity, its association with blindness and even mortality. Delayed presentation and nonspecific symptoms present peculiar challenges in diagnosis and management to the ophthalmologist. This descriptive retrospective study was done to characterize fungal infections of orbit in terms of demographic variables and associated risk factors as well as to describe the clinical spectrum and outcomes of the disease. Materials and Methods: The study is a retrospective, clinicopathological analysis of invasive fungal orbital disease presenting at a tertiary care multi-speciality centre. Data collected included demographic details as well as any medical or surgical morbidities, ongoing treatment, clinical examination findings which included detailed ophthalmologic examination, findings of routine investigations as well as HIV serology, orbital and neuro imaging reports. Treatment outcome details were also recorded from medical follow up records. Results: 20 cases of fungal infections of orbit due to microbiologically confirmed mucormycosis or aspergillosis were identified during this period. Continuous data was presented in median (interquartile range) and categorical data was represented in frequency (%). Mann Whitney u test was used for continuous data and Fischer exact test was used to compare proportions. Patients with mucor mycosis had higher mortality (53.3%) than aspergillosis (25%). Extension to brain, haematological malignancy and AIDS are negative prognostic factors. Conclusion: Orbit involving mucormycosis infection is more common and has higher mortality than aspergillosis. Late presentation is more common in developing countries. Keywords: Fungal infections, Ocular motility disorders, Orbital disease.

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Abstract

Purpose: To analyse the etiology of epiphora in the adult age group in a tertiary care centre in a developing country and the type of surgical intervention needed in those not amenable to medical management. Materials and Methods: Ninety-eight adult patients with primary complaint of epiphora were analysed retrospectively. The patients included were those who had either some obstruction in the lacrimal drainage pathway or had poor apposition of punctum to the globe. Reflex tearing or primary hypersecretion as a causative factor was excluded from the study. Descriptive statistics of the continuous data was presented using mean± standard deviation / median (interquartile) and range while categorical data in frequency (%). To compare the proportions between the groups, Fisher exact test was used where the expected frequency in at least any cell was less than 5. P value Results: Mean ± standard deviation and median (interquartile) of the patients age (in years) was 53.37±13.71 and 57(42-65) respectively with range of 20-77 years. External dacryocystorhinostomy (with or without intubation) was the most common surgery performed (n=50, 51%) followed by punctal surgeries (n=21, 21.4%) and lower lid ectropion correction (n=17, 17.3%). Conclusion: In the 98 patients studied, external dacryocystorhinostomy was the most performed surgery for lacrimal passage obstruction. Older female patients are more susceptible to nasolacrimal blockage than the male patients while obstruction in the upper lacrimal apparatus is more common in younger males. Lateral tarsal strip is the most performed surgery for lower lid ectropion. Keywords: Dacryocystorhinostomy, Epiphora, Ectropion, Entropion, Punctal stenosis.

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