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To present the spectrum of clinical presentation in forty cases of rhino-orbital mucormycosis along with the epidemiological, radiological and microbiological data and to highlight the factors in decision making for orbital exenteration.

A retrospective analysis of 40 patients of proven rhino-orbital mucormycosis managed at a tertiary hospital in New Delhi, India, between 2009 to 2019, was carried out. The study analysed epidemiological, laboratory and radiological data with management outcomes. Seven of the forty cases received liposomal amphotericin B (L AmB) mono-therapy while 33/40 received a combination therapy of L AmB and Posaconazole. All patients underwent Functional Endoscopic Sinus Surgery (FESS). Orbital exenteration was carried out in patients presenting with no perception of light and Central Retinal Arterial Occlusion, complete ophthalmoplegia along with radiological features suggesting either risk of or presence of intracranial extension. Bilateral disease and patients with extensive intracranial spread with little chance of survival were relative contraindications.

The average age at presentation was 51years. The most common predisposing factor was Diabetes Mellitus (36/40 cases). Cerebral involvement was seen in 18/40. FESS with orbital Exenteration was carried out in 25/40 cases while 15/40 underwent FESS alone. The minimum follow up period was 3 months unless the patient died earlier. Overall death rate was 30%, with 12% mortality in orbital exenteration with FESS and 60% in FESS alone.

Diabetes Mellitus was the most common predisposing factor. Early diagnosis of mucormycosis and Timely exenteration in the appropriate cases may help improve survival rates.