A case of conjunctival leech infestation

Ocular infestation by a juvenile leech, Myxobdella sinanensis in Japan

Purpose

The case of ocular infestation by a leech is rare. We reported that Myxobdella sinanensis infests conjunctiva.

Observations

A 5-year-old girl presented with blood clots in the inner corner of the left eye, and a history bloody eye discharge and bloody tears for 5 days. She was prescribed 0.5% levofloxacin ophthalmic drops for conjunctival damage. However, her parent watched a worm moving in her conjunctiva while taking a bath. She presented again the same day, and a worm was found in the left eye of the lower conjunctival fornix and was adsorbed to the inner corner. We removed a worm under eye drop anesthesia, the next day the patient had no symptoms. We captured the worm, and it was identified morphologically and genetically as Myxobdella sinanensis. This was the first case reported of Myxobdella sinanensis be infestation in a human.

Conclusions and Importance

The ecological trait of Myxobdella sinanensis still did not remain clear, so this case report was helpful to find out a life cycle of Myxobdella sinanensis. As the outdoor population continues to increase, the cases of human parasites such as leech are expected to increase. When a patient with bloody eye discharge and bloody tears presents, we should carefully examine the conjunctiva and ocular surfaces, and interview recent history of exposure to stream water.

Adult ocular leech infestation

Ocular trauma accounts for a significant proportion of cases in any emergency eye outpatient department. There are very few cases reporting ocular injuries after leech exposure. Leeches are annelids belonging to the subclass Hirudinea; they dwell in fresh water and the sea and can be terrestrial. An oral sucker present anteriorly helps to attach to the host by releasing an anesthetic that prevents its recognition as a foreign body. Although many methods of leech removal have been proposed, its removal with forceps after instillation of local anesthetic remains a safe and effective method.

Ocular leech infestation

This case report describes a female toddler with manifestations of ocular leech infestation. A 2-year-old girl was brought to our outpatient clinic with a complaint of irritable crying after being taken to a stream in Hualien 1 day previous, where she played in the water. The parents noticed that she rubbed her right eye a lot. Upon examination, the girl had good fix and follow in either eye. Slit-lamp examination showed conjunctival injection with a moving dark black–brown foreign body partly attached in the lower conjunctiva. After applying topical anesthetics, the leech, measuring 1 cm in length, was extracted under a microscope. The patient began using topical antibiotic and corticosteroid agents. By 1 week after extraction, the patient had no obvious symptoms or signs, except for a limited subconjunctival hemorrhage, and no corneal/scleral involvement was observed.