Varied Aetiology of Orbital Cellulitis at Tertiary Care Center in India during COVID-19 Pandemic: A Case Series

Purpose: To study the cases of Orbital Cellulitis presenting to tertiary care centre with varied aetiologies during the COVID-19 lockdown in India. Design: Cross Sectional study. Methods: Cases presenting with features of orbital cellulitis at M & J Institute of Ophthalmology during COVID-19 related lockdown (23rd March 2020 - 30th June 2020) were studied with respect to the aetiology, signs, symptoms, past history, different clinical presentations, treatments, investigations and associated complications. Results: A total 21 cases of Orbital cellulitis were identified including 19 males and 2 females (9.5:1). The median age was 47 years (3-71 years). Average duration of onset of symptoms before presenting at hospital was around 34 days (4-60 days). 13 had Infective, 6 had Neoplastic, 1 had Traumatic and 1 had Vascular as well as Infective etiology. 9 patients had Orbital mucormycosis as the cause of Infective aetiology. 19 (90%) had unilateral and 2(10%) had bilateral presentation. Conclusions: Our study highlights the abnormally increased incidence of orbital cellulitis during COVID-19 pandemic restrictions. Orbital mucor infection was the most common aetiology in COVID-19 positive patients. Most can be managed effectively by parental antibiotics, anti-fungals and if there is poor response with medical therapy, surgical treatment may be sought. Role of steroid is emerging however it might be the culprit behind the development of orbital mucormycosis especially in patients with COVID-19 infection. More future studies are required to establish the exact relation between COVID-19 infection and Orbital mucormycosis.