Indian Journal of Ophthalmology

: 2004  |  Volume : 52  |  Issue : 2  |  Page : 171--2

Rhino-orbito-cerebral mucormycosis

Philip A Thomas, P Geraldine 

Correspondence Address:
Philip A Thomas

How to cite this article:
Thomas PA, Geraldine P. Rhino-orbito-cerebral mucormycosis.Indian J Ophthalmol 2004;52:171-2

How to cite this URL:
Thomas PA, Geraldine P. Rhino-orbito-cerebral mucormycosis. Indian J Ophthalmol [serial online] 2004 [cited 2020 Jun 3 ];52:171-2
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Dear Editor,

We congratulate Nithyanandam et al[1] on their excellent paper describing the clinical features and treatment outcomes in a series of patients with rhino-orbito-cerebral mucormycosis. However, we would like to request a few clarifications:

The authors rightly state that demonstration of tissue invasion on histopathology is mandatory for a diagnosis of mucormycosis. Was such tissue invasion seen in samples collected from patients with clinical stage I disease (defined as limited sino-nasal disease)? If not, could this group of patients have been suffering from isolated zygomycetous fungal sinusitis[2] or a fungal ball of the sinus,[3] rather than rhino-orbito-cerebral mucormycosis? This could partly explain the excellent treatment outcome (success in 10 of 11 patients) achieved by sino-nasal debridement alone, with or without palatal resection.

Rhino-orbito-cerebral mucormycosis is known to exist in two forms, the well-known acute form and the less well-recognised chronic form. Interestingly, the most common presenting features of the chronic form are ophthalmologic, including ptosis, proptosis, visual loss and ophthalmoplegia, and surgical resection of necrotic tissue is an important component of disease management.[4] Could some of the patients with clinical stage II and III disease seen by the authors have been suffering from chronic rhino-orbito-cerebral mucormycosis?

Although the authors state in the Discussion that surgical clearance of all infected tissues, including an exenteration , is mandatory for the clinical stage III of the disease, they have not explained why none of their seven patients in this stage underwent any surgical procedure.

Since rhino-orbito-cerebral mucormycosis is most commonly caused by species of the zygomycetous fungus Rhizopus , and less frequently by Mucor species, some authors suggest that this disease entity be referred to as 'rhino-orbito-cerebral zygomycosis'.[5]


1Nithyanandam S, Jacob MS, Battu RR, Thomas RK, Correa MA, D'Souza O. Rhino-orbito-cerebral mucormycosis. A retrospective analysis of clinical features and treatment outcomes. Indian J Ophthalmol 2003; 51: 231-36.
2Goldstein MF, Dvorin DJ, Dunsky EH, Lesser RW, Heuman PJ, Loose JH. Allergic Rhizomucor sinusitis. J Allergy Clin Immunol 1992; 90: 394-404.
3Goodnight J, Dulguerou P, Abemayor E. Calcified Mucor fungus ball of the maxillary sinus. Am J Otolaryngol 1993; 14: 209-10.
4Harril WC, Stewart MG, Lee AG, Cernoch P. Chronic rhinocerebral mucormycosis. Laryngoscope 1996; 106: 1292-97.
5Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. Clin Microbiol Rev 2000; 13: 236-301.