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ARTICLES
Year : 1985  |  Volume : 33  |  Issue : 4  |  Page : 249-250

Noma-a case report


Department of Ophthalmology, Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi, India

Correspondence Address:
P A Lamba
Professor of Ophthalmology, Lady Hardinge Medical College New Delhi-110001
India
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Source of Support: None, Conflict of Interest: None


PMID: 3842833

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How to cite this article:
Jain M, Sarkar N, Lamba P A. Noma-a case report. Indian J Ophthalmol 1985;33:249-50

How to cite this URL:
Jain M, Sarkar N, Lamba P A. Noma-a case report. Indian J Ophthalmol [serial online] 1985 [cited 2020 Nov 29];33:249-50. Available from: https://www.ijo.in/text.asp?1985/33/4/249/30802

NOMA, a synonym of cancrum oris is seen occasionally in severely malnourished young children'. This condition manifests itself in the form of acute virluent gangrene at the angle of the mouth spreading exten­sively to surrounding tissues and underlying bone[1],[2]. Usually these children fail to thrive resulting in high mortality irate [2],[4]. No pathogenic organism could ever be isolated to be responsible for acute necrosis, although vincenti organisms were detected in few[3]. The present case is reported with the interest of rarity of the condition involving the lids[4] and its successful management.


  Case report Top


A 6 months old female child was admitted to paediatric ward of this hospital for chronic diarrhoea, inability to gain weight and a swelling at the root of the nose on the left side with the provisional diagnosis of acute dacryocystis. Within 24-48 hours the swelling was replaced by massive destruction of the tissue resulting in a big gap with exposure of the underlying lacrimal and nasal bone when the case was referred to the Department of Ophthalmology for consulta­tion. On examination an ulcerated area i cm X 1 cm X 1 cm was observed involving the medial ends of both lids, caruncle and punctum without any evidence of cancrum oris or involvement of genitalia [Figure - 1]A. The base of the ulcer was formed by the lacrimal and the nasal bone and was filled with yellowish white necrotic material. The margins did not show any reaction or signs of inflammation. Except for the gangrenous destruction of the lids, rest of the eye was normal.

The results of routine investigations were normal and X-ray showed no bony defect. Repeated cultures from the lesion were sterile. Intensive local treatment comprising of clean­ing of the ulcer with hydrogen peroxide to remove necrotic tissue and application of antibiotic drops and ointment with simul­taneous improvement of general condition of the child by dietary and medical means resulted in marked recovery of the lesion. The diarrhoea was checked. The ulcer started filling up with narrowing of the gap. The wound margins were approximated to almost normalisation with minimal puckering and a mild lid defect [Figure - 1]B. The child was discharged within four weeks.


  Discussion Top


Cancrum oris (Cancrum, a sore: oris, of the mouth) also called Water Canker or Noma, is a gangrenous ulcer around the mouth which affects week children, especially after some-severe disease, such as measles[5]. The term cancrum oris signifying sore around the mouth does not appropriately reflect the condition as seen in the 'present case. Using this term synonymous with noma is considered a misrepresentation. NOMA affecting only the eyes and the lids without any evidence of cancrum oris is a very rare condition. However, with extensive cancrum oris, the gangrenous destruction involving the lids and globe is known. Very often the noma follows an attack of measles in undernourished children[2],[5], but in our case no such history was found. The condition when it starts as swelling at the medial end of the eye as in the present case, could be misdiagnosed as dacryocystitis if proper follow up is not done. The recovery shown by this child was surprising in contrast to high mortality rate reported in such cases[2]. The simple meticulous local management to prevent secondary infection coupled with improvement of the general health is all that is needed to treat this condition. It is therefore, emphasized that ophthalmo­logist should never shirk managing such cases by referring them to a dermatologist.

 
  References Top

1.
Pindborg J.J, 1979, Disorder of oral cavity & lips. Text Book of Dermatology, Edited by Arthur Rook London, Blackwell Scientific Publications, p. 1871.  Back to cited text no. 1
    
2.
Duke Elder S., 1974, System of Ophthalmology Vol- XIII. London, Henry Kimpton, p. 47.  Back to cited text no. 2
    
3.
Mackay, 1979, Brit. Med. 1 : 223.  Back to cited text no. 3
    
4.
Chaddah, M.R, Khanna, K K, 1968, Orient Arch Ophthalmol. 6:179.  Back to cited text no. 4
    
5.
Williams, A.R, Thomson, 1958, Blacks Medical Dictionary. London, Adom & Charles Black, p. 158.  Back to cited text no. 5
    


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