A 60 year old female patient presented to the out patient department with complaints of worms crawling out of a wound below the right eye, associated with pain and foul smelling discharge since 2 months. On careful history taking and seeing her old photographs, the patient had a black coloured lesion below the right eyelid since 5 years for which she had applied some herbal medication (Figure 1). On examination of the right orbit, hundreds of maggots were seen crawling out of an ulcerative, foul smelling, fungating lesion, extending from the medial canthus up to the lateral orbital wall involving the floor, measuring about 12x4cm ( Figure 2). The visual acuity of the right eye was 6/60 with a normal anterior segment and fundus. Ocular movements were totally restricted. The left eye was normal. Guaze pieces soaked in medical turpentine oil were placed throughout the lesion and the maggots which crept out were removed manually by forceps (Figure 3). This was done on three consecutive days till the lesion was totally free of maggots. After a week of daily dressing ,the ulcerated lesion healed with granulation tissue (Figure 4). Broad spectrum antibiotics were given. Protein supplements and multivitamin injections were given as the general condition of the patient was very poor. Haematological and biochemical investigations revealed leucocytosis and hypoalbuminemia. Contrast CT of paranasal sinuses and orbit revealed bilateral maxillary, ethmoid and sphenoidal sinusitis, osteomyelitis of right lamina papyracea and right orbital and periorbital cellulitis, but no evidence of intracranial spread ( Figure 5). Biopsy from the margins of the lesion was sent for histopathology. The collected larvae were sent to entomology for identification. Histopathological diagnosis confirmed Basal cell carcinoma (BCC) ( Figure 6) and larvae morphologically resembled oestrus ovis larvae. After consulting the oncosurgeon, wide local excision with exenteration of the right orbit was planned but the patient refused the surgery. DiscussionBCC most frequently arises from the lower eyelid, followed in relative frequency by medial canthus, upper eyelid and lateral canthus. It is a slowly growing, locally invasive

Purpose: To assess the outcome and response of transcutaneous retrobulbar injection of amphotericin B (TRAMB) in post-coronavirus disease of 2019 (COVID-19) rhino-orbito-cerebral mucormycosis (ROCM) and to establish a scoring system in guiding treatment modalities. Methods: An interventional, prospective study was done on 82 eyes of post-COVID-19 ROCM from May 2021 to July 2021. A comprehensive multi-departmental evaluation along with detailed ophthalmic examination, laboratory investigations, and radiological examination was done. Scoring points were given to each symptom, sign, and radiological features of orbit and the total score was taken. Based on these scores, severity of disease was grouped into A, B, and C corresponding to mild, moderate, and severe orbital ROCM. One milliliter of reconstituted liposomal amphotericin B was given to all patients every alternate day as three doses. Efficacy of these injections was assessed in all groups, even though other treatment modalities like orbital debridement and exenteration were considered for moderate and severe cases. Patients were followed up for a period of 8 weeks. Results: Out of 82 eyes, symptomatic improvement was seen in a major proportion (72%) of patients. A statistically significant improvement in scores was noted in group A (93% improved) with a P value of 0.002, while 68.4% showed improvement in group B ( P -value- 0.0001). Group C with severe disease showed minimal improvement in post-injection scores of 41% ( P -value 0.086), necessitating surgical intervention. No serious adverse effect of the drug or procedure was noted. Conclusion: Significant improvement in scores of groups A and B highlights TRAMB as an effective and safe treatment modality in mild to moderate ROCM. It is an effective adjunct in severe cases, along with other interventions. Also, the scoring system helps in assessing the severity and guiding in management strategies.

COVID-19 is a respiratory virus, which has affected various organ systems as well. Here we report a neuro-ophthalmic presentation of pituitary apoplexy under the setting of COVID-19 infection in a middle-aged man who presented to ophthalmic emergency with sudden bilateral loss of vision along with a history of fever past 10 days. There was sluggishly reacting pupils and RT-PCR for COVID was positive. Imaging pointed the diagnosis as pituitary macroadenoma with apopexy. In view of pandemic situation, patient was given symptomatic treatment as per the protocols and stabilized. Vision also showed improvement to some extent and the patient is awaiting neurosurgery