A primary intraocular hydatid cyst

Infective pulmonary diseases and the eye: a narrative review

Several infectious pulmonary diseases affect the eye. An understanding of the association between infectious pulmonary and ocular diseases is pivotal to their successful management. We aimed to review the infections affecting both the lungs and the eye. The electronic database PubMed and the search engine Google Scholar were searched for relevant articles. Ocular tuberculosis (TB), usually not associated with clinical evidence of pulmonary TB, can affect almost all the ocular structures. Confirmation of the diagnosis of ocular TB requires demonstration of Mycobacterium tuberculosis in ocular fluids/tissues. Among the drugs used to treat TB, ethambutol, isoniazid, and linezolid may cause toxic optic neuropathy. Elderly, those with renal disease, diabetes mellitus, malnourished, alcoholics, and those who will receive ethambutol at doses greater than 15 mg/kg/day and for prolonged periods are at high risk of developing toxic optic neuropathy. These individuals should be referred to an ophthalmologist before initiating ATT for a baseline ophthalmic evaluation. Linezolid may also cause toxic retinal neuropathy. Rifampicin may cause yellowish-orange discoloration of tears and contact lenses. Adenovirus, coronavirus, influenza virus, respiratory syncytial virus, and rhinovirus exhibit both pulmonary and ocular tropism. Pneumocystis jirovecii choroiditis is rare and mainly seen when aerosolized pentamidine is used for pneumocystis pneumonia prophylaxis. Further research is needed to develop non-interventional strategies to diagnose ocular TB. Biomarkers for early detection of toxic optic neuropathy are a need of the hour. Genetic factors and mechanisms behind the development of ethambutol, isoniazid, and linezolid-induced toxic optic neuropathy need further study.

Giant Primary Intracranial Hydatid Cyst in Child with Hemiparesis

Hydatid cyst is the larval form of the parasite Echinococcus. Echinococcus granulosus and less commonly Echinococcus multilocularis species cause the disease. Intracranial hydatid disease is relatively rare; the incidence is approximately 1%-2%. Intracranial hydatid cyst can be classified as primary and secondary. A primary cyst, the most common type, is always solitary. The treatment of hydatid cyst is surgical, and the aim of surgery is to remove the cyst without rupture to prevent recurrence or anaphylactic reaction. The Dowling technique (improved by Arana-Iniguez and San Julian) has been widely used for the excision. Albendazole and praziquantel are the medical treatment of choice. In recurrent cases or cases with rupture during surgery, medical therapy has been reported to be effective. Preoperative and postoperative albendazole may be considered to sterilize the cyst, decrease the chance of anaphylaxis, lower the tension in the cyst wall, and reduce the recurrence.

Pigmented Congenital Vitreous Cyst

Purpose

To describe the clinical findings in a case with a typical pigmented congenital vitreous cyst and to discuss its differential diagnosis.

METHODS/CASE REPORT

A 24-year-old woman complaining of floaters and blurring of vision during eye movements in the right eye was examined.

Results

A diagnosis of congenital vitreous cyst was made after detailed viteoretinal examination, B-scan ultrasonography (eye and abdomen), computerized tomography of brain, chest radiogram, serologic tests for Echinococcosis and Cysticercosis in the serum, and complete blood count for eosinophilia. Clinical presentation and the patient's complaints remained unchanged during 3 years of follow-up.

CONCLUSIONS

Congenital vitreous cysts are benign lesions. Differential diagnosis from acquired cysts requires careful clinical examination and appropriate laboratory tests.

Subdural hydatid cyst presenting as recurrent subdural hygroma

Intracranial hydatid disease is an uncommon entity that usually is parenchymal in location. Presence of hydatid cyst in subdural location is being reported for the first time in the literature. A 13-year-old female child with the diagnosis of hydatid disease of brain was operated. She was advised to take albendazole which she did not take. In postoperative period she developed recurrent subdural hygroma for which multiple surgical interventions were done and finally cause of recurrent subdural hygroma was found to be hydatid cyst in the subdural space. The patient had initially undergone craniotomy for the excision of hydatid cyst. Later on she developed subdural hygroma for which the burr hole drainage was done twice. At time of third recurrence subduro-peritoneal (SDP) shunt was done. When she had recurrence again along with hydrocephalus, than VP shunt and revision of the SDP shunt was planned. While doing revision of SDP shunt, hydatid cyst was seen emerging from the burr hole site. A craniotomy was done to remove the hydatid cyst from the subdural space. Since then there has been no recurrent collection. Complete surgical excision is the best treatment modality to treat hydatid cyst of brain. Accidental spillage of the contents can have lead to recurrence, so every effort must be taken to prevent spillage of contents. Postoperatively all the patients must be put on antihelminthics.

Giant hydatid cyst in the posterior fossa of a child

The hydatid cyst (HC) is endemic in Mediterranean region including Syria. The central nervous system is involved in 2–3% of cases. HC in cerebellum is very rare. We report a case that presented as an emergency for high intracranial pressure and deteriorating Glascow coma scale. Close monitoring and precise surgical management using Dowling's technique resulted in very good outcome with full recovery. We highlight the need for very careful surgical treatment because cyst rupture and secondary hydatidosis due to spillage of the cyst contents can dramatically worsen the outcome. HC should be taken into consideration in countries where hydatid infestation is endemic.

[Partially pigmented vitreous cyst]

Free-floating iris pigment epithelial cysts in the vitreous are very rare. We report the case of a partially pigmented cyst found on routine examination in the vitreous of a 51-year-old asymptomatic patient. Usually, non-pigmented cysts are derived from the hyaloid system. Pigmented cysts, however, are derived from the iris pigment epithelium. When they are not dislodged, these cysts can be confused with iris melanoma or primary stromal cysts. Treatment is usually unnecessary, unless they become symptomatic.

Young girl with multiple intracranial hydatid cyst

8 years young girl presented with uncontrolled seizures in obtunded and bedridden state. MRI brain showed multiple extra-axial coalescent cystic lesions in bilateral frontotemporo parietal regions - diagnosed as multiple hydatid cyst. We used irrigation saline during surgery and a total 35 cysts were removed intact, one by one separately and histologically confirmed as hydatid cyst. Postoperatively, patient showed marked neurological improvement and was seizure free.

[Vitreous cyst: a case presentation]

CASE REPORT

We report a case of a 12-year-old patient who complained about visual disturbances in left eye for 6 months. His visual acuity was 1/0.9, funduscopy in left eye revealed a free-floating cyst in the anterior vitreous. Magnetic resonance showed a low intense image in T1, and B-scan ultrasound confirmed a hypoechogenic cyst of 3.2 × 4.3 mm; ultrasound biomicroscopy revealed a normal ciliary body.

CONCLUSION

Given the good VA the patient will be monitored periodically. If the cyst interferes with visual axis, management with Nd:YAG or Argon laser photocystotomy or remove it by pars plana vitrectomy has been advocated.

Zoonotic helminths affecting the human eye

Nowaday, zoonoses are an important cause of human parasitic diseases worldwide and a major threat to the socio-economic development, mainly in developing countries. Importantly, zoonotic helminths that affect human eyes (HIE) may cause blindness with severe socio-economic consequences to human communities. These infections include nematodes, cestodes and trematodes, which may be transmitted by vectors (dirofilariasis, onchocerciasis, thelaziasis), food consumption (sparganosis, trichinellosis) and those acquired indirectly from the environment (ascariasis, echinococcosis, fascioliasis). Adult and/or larval stages of HIE may localize into human ocular tissues externally (i.e., lachrymal glands, eyelids, conjunctival sacs) or into the ocular globe (i.e., intravitreous retina, anterior and or posterior chamber) causing symptoms due to the parasitic localization in the eyes or to the immune reaction they elicit in the host. Unfortunately, data on HIE are scant and mostly limited to case reports from different countries. The biology and epidemiology of the most frequently reported HIE are discussed as well as clinical description of the diseases, diagnostic considerations and video clips on their presentation and surgical treatment.

Free-floating unilateral pigmented vitreous cyst in a child

Free-floating vitreous cysts have been ocular curiosities, especially in children. Various etiologies have been proposed. Most of these cysts are asymptomatic except for subtle symptoms of visual floaters. When the visual axis is obscured, treatment options include surgery and laser treatment. We report a case of a unilateral pigmented vitreous cyst in a child.

Hydatidosis of the Orbit in Turkey: Results from Review of the Literature 1963–2001

Hydatidosis can involve almost every organ or tissue in the body via the systemic circulation, but hydatid infestation of the orbit comprises far less than 1% of the total incidence. This study investigated the data on all patients of orbital hydatid disease reported in Turkey since 1963. In this meta-analysis, a total of 25 patients were included and slowly progressive unilateral proptosis, with or without pain, was the most frequent clinical manifestation (80%). The other presenting symptoms were visual loss (48%), periorbital pain (24%), chemosis (16%), and headache (12%). The presumptive diagnosis of hydatid cyst was made on the images obtained from ultrasonography (US), computed tomography (CT) and/or magnetic resonance imaging (MRI) examinations. These diagnostic studies demonstrated a well-circumscribed cystic mass in almost all patients. Total surgical removal without rupture remains the best mode of therapy for orbital hydatid disease. The study indicates that in Turkey hydatidosis remains a serious problem, causing blindness. Orbital hydatid cyst should be included in the differential diagnosis of unilateral proptosis and visual handicap in patients from countries where hydatidosis is endemic.