How Mucormycosis or Black Fungus Affect Eyes?

Does Mucormycosis spread? Is there treatment for black fungus? How Mucormycosis reach the eyes? These and many such queries are answered by our expert Dr. SUSHMA Reddy Katukuri, Consultant Ophthalmologist at Rainbow children’s hospital Banjara Hills.

Basically, this Mucormycosis fungus is ubiquitous in nature and is widespread in the environment. It can be present in the soil, on the decayed vegetables or fruits, any organic waste, etc. So the fungal spores present in the air when inhaled reach the sinuses first and from there they involve the eye, so initially, in the early stages patients have symptoms of sinusitis like nasal congestion, nasal discharge- brown or black, facial pain, facial numbness and swelling, headache, tooth pain or loosening of tooth, and as it reaches the eye, patients will have blurred vision, double vision with pain, eye swelling or protrusion, fever.

So, in the early stages, patients have symptoms of sinusitis like nasal congestion, nasal discharge- brown or black, facial pain, facial numbness and swelling, headache, tooth pain or loosening of tooth,

Causes ofrising cases:

As this fungus is so widespread in nature humans get exposed on regular basis but it rarely causes infections because if the immune system is intact and strong, the fungus does not show any effects, only if the immune system is weak fungal spores will germinate and hyphae formation will occur and infection develops. So now in today’s scenario, there is

1. long term use of steroids in COVID patients will result in uncontrollable blood glucose levels which in turn will reduce immunity and can predispose to infection and
2. another thing is immune suppression by the virus itself can be the cause of this infection.
3. Use of other immunomodulatory medications like Tocilizumab.
4. Inappropriate use of antibiotics in COVID patients.
5. Contaminated oxygen delivery devices or water used in humidifiers.
6. Prolonged use of unhygienic and contaminated masks.
7. Increased use of industrial-grade oxygen for medical purposes.
8. excessive use of zinc supplements

All these could be the reasons for raising cases.

Precipitating factors:

As already mentioned low immunity levels due to various reasons and COVID infection with other comorbid issues like AIDS,uncontrolled diabetes mellitus, cancers such as lymphomas, kidney failure, organ transplant, and cirrhosis, energy malnutrition, and deferoxamine therapy could be precipitating causes for Mucor.

Presentation in immuno-compromised patients:infection is seen mostly in immunocompromised patients.

Kids: not yet seen/reported. The youngest is 17 yrs and the presentation is no different from that of adults.

Warning signs: By the time signs of eye involvement develop, it is often too late to save the patient’s vision, or even the patient’s eye or life. so any mild nonspecific symptom as mentioned earlier especially in post-COVID patients and poor glycaemic control patients and those who received long-term steroids should be considered as Mucor until unless proved, immediate attention to investigate symptoms has to be taken up.

When to seek professional help: The presentation is typically a rapidly progressive infection, and the disease is associated with a high mortality rate. The time from onset of initial symptoms to late symptoms and signs that are diagnostic of the disease may be as short as one day. So, all suspected patients with any nonspecific symptom should inform their treating doctor.

Limit the use of steroids

• Systemic steroids should only be used in patients with hypoxemia

• Oral steroids are contraindicated in patients with normal oxygen saturation on room air

• If systemic steroid is used, blood sugar should be monitored

• The dose and duration of steroid therapy should be limited to dexamethasone (0.1mg/kg/day) for 5-10 days

How it can be life-threatening

The fungus invades blood vessels and causes blood clots and thus tissue infarctions. When the fungus invades the paranasal sinus mucosa, it may spread directly to the orbital apex and, from there, gain access to the brain, causing vascular thrombosis (blood clots) and infarction. (stroke) and can be fatal. Mucormycosis is aggressively invasive, and thus, the progression of the infection may be very rapid.

Pain swelling redness, watering, protrusion, unable to move eyeball (restricted movement of the eye) blurred vision, loss of vision, double vision.

How to prevent this infection

• As poorly controlled diabetes is the major issue, good glycaemic control during the management of COVID-19 patients is required.

Steroids are to be given as per the protocol.

• Universal masking reduces exposure to Mucorales; avoidance of construction sites

• During discharge of the patients, advice about the early symptoms or signs of Mucormycosis (facial pain, nasal blockage, and excessive discharge, loosening of teeth)

Awareness regarding hygienic practices in handling oxygen supply.

Avoiding reuse of masks without washing.