Covid-19: Understanding Black Fungus and it's effects on the eyes

Our country is already battling with the second wave of COVID 19. And, in the midst of all this chaos, we are now bombarded with various horror stories of Black Fungus. The following information should be able to make you aware of this entity, which if diagnosed on time can save a lot of eyes and lives.

Mucormycosis, commonly called Black Fungus, isn't a new disease, it’s an aggressive fungal infection that enters the body through the nose. It is actually omnipresent — like in old cupboards, on our dusty books and papers, on fungus-laden stale bread and even in the air we breathe. But we usually don't get affected by it since our immunity takes care of it. It is an opportunistic disease seen in low immunity conditions such as diabetes, patients undergoing chemotherapy, immunosuppressed patients who have undergone transplant surgeries, etc. Our doctors such as the neurosurgeons, maxillofacial, ENT, dental surgeons and ophthalmologists have been tackling this condition very effectively with timely administration of antifungal intravenous medication and surgical removal of the affected tissue.

Why is there a sudden surge?

This mutant Covid-19 virus is known to lower the overall immunity of a person, giving rise to many secondary bacterial and fungal infections. India is the ‘diabetes capital’ of the world. Covid and diabetes as a combination is turning out to be a deadly gateway to this group of moulds called mucormycetes. Sheer high number of positive cases during the second wave has inadvertently increased the number of Mucormycosis cases. Moreover, because of the survival benefit offered by steroids in moderate Covid infections with hypoxia (SPO2 below 94) makes them an imperative part of therapy. Steroids suppress immunity, making it a double-edged sword.

The early symptoms begin with nasal congestion since the nose is the point of entry. As the fungus settles in the sinuses, it may cause sinusitis-like pain. Mucormycosis infections are characterised by extensive angioinvasion that results in blood vessel thrombosis. The subsequent Ischemic necrosis (death of tissue due to blockage of blood supply) of the infected tissues can prevent delivery of WBCs and antifungal agents to the foci of infection. Hence, the infected tissue needs to be surgically excised.

Threat to eyesight

Very often the presenting symptom is drooping of the eyelid. The fungus corrodes through the nasal cavity and enters the orbital cavity (the eye socket). The patient may complain of double vision, blurred vision or complete blindness. Within a day or two the eye becomes proptosed —menaing, it bulges. The standard therapy for rhino-orbital mucormycosis has been intravenous amphotericin B, extensive sinus debridement, and orbital exenteration to prevent intracranial (brain cavity) extension of this infection.

Mucormycosis is a threat to sight and even life but timely diagnosis and treatment can save both. Sometimes, the doctors have to make this tough decision to choose life over sight. The disease may enter the oral cavity and cause loosening of teeth which could also be the presenting feature.

Strict control of Diabetes, rational use of steroids and 0.5% povidone Iodine nasal drops two to three times a day can reduce the incidence of this disease in these Covid times. Please do not lose sleep over black fungus, rather be aware.

(The write is Consultant Ophthalmologist and Surgeon at SaiNetra Advanced Eye Care)

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