Subconjunctival Dirofilaria masquerading as nodular scleritis

A man in his late 50s presented with a gradually enlarging, painless, reddish mass on the white portion of his left eye for 2 weeks. His best-corrected visual acuity was 20/20 in both eyes. Slit-lamp examination showed a congested, nodular, elevated lesion on the temporal bulbar conjunctiva with two pustule-like elevations. Anterior segment optical coherence tomography showed a subconjunctival solid mass rather than an abscess or a cyst. Scleral deroofing was performed and a long thread-like object resembling a dead worm was identified. The worm was removed intact, and its histopathology confirmed the diagnosis of Dirofilaria Peripheral blood smear did not show any microfilariae. No recurrences or new lesions were observed during the follow-up examinations at 1 and 5 months post-surgery. This case highlights the importance of considering a parasitic aetiology in cases of nodular or infectious scleritis.

Bilateral maculopathy in a patient with ataxia telangiectasia

We report a case of toxoplasmosis with bilateral maculopathy in a 7-year-old boy diagnosed with ataxia telangiectasia (AT) at age 6. AT manifests as ataxia, apraxia, telangiectasia, and dysarthria. Common ophthalmologic findings in AT include fine conjunctival telangiectasia. Patients also suffer from recurrent sinopulmonary infections; however, serious opportunistic infection is rarely diagnosed. At 8 years of age he developed disseminated Toxoplasma gondii (toxoplasmosis) infection and meningoencephalitis. This ophthalmologic finding and the subsequent toxoplasmosis meningoencephalitis have not been previously reported in AT.

Giant mass conjunctival rhinosporidiosis causing severe mechanical ectropion

Rhinosporidiosis is a granulomatous disease of the mucous membrane caused by Rhinosporidium seeberi, an organism of uncertain taxonomic position, most probably a fungus. It usually infects mucous membrane of the nose and nasopharynx but may infect mucous membrane of all other parts even the skin. Inoculation of the eye and related structures are grouped as oculosporidiosis. In this case of a 50 years old male agriculturist from remote village had complaints of a mass protruding out from the palpebral fissure since last one year. It was gradually increasing in size and shape. There was recurrent redness, watering and discharge. This mass caused dragging of lower lid to produce mechanical ectropion. On examination there was a pedunculated polypoidal broad based conjunctival mass originated from inferior bulbar conjunctiva. It is chemosed with the evidence of necrosis and old haemorrhagic spot, engorged conjunctival vessel and in the exposed pert there is keratinisation. Conjunctival rhinosporidosis has predilection for agriculture workers so that contact with contaminated soil may be the causative factor. The only effective treatment is radical surgical excision followed by thermal and chemical coagulation, nevertheless relapse is the rule rather the exception. No such medical treatment has proved to be effective. Griseofulvin and amphotericin have been used without success.

[Conjonctival human myiasis by Oestrus ovis in Northern Africa]

Following the publication of a paper on Conjonctival human myiasis by Oestrus ovis in southern Tunisia by Anane and Ben Hssine (Bull Soc Pathol Exot (2010) 103(5):299-304), the author reminds that the discovery of this disease was made in Algeria, in 1907 by Edmond and Etienne Sergent.

[Subconjunctival nodule with Dirofilaria repens]

Dirofilaria repens infection, a zoonotic illness, is rarely seen in humans; it is more frequently met over the endemic areas of the Southern Europe and Sri Lanka. The authors report a case of dirofilaria conjunctivae in a 27 year old woman from Craiova; such infections are hardly to be found in our country. Our patient presented a mobile, bulbar, subconjunctival tumoral formation which was surgically removed; immature Dirofilaria repens was revealed into it. Case particularity was that the patient had not visited any of the endemic areas. Environmental changes with global warming can lead to some new unspecific diseases in our country.

Subconjuctival Loa loa with Calabar swelling

Loa loa is unique among the human filariae in that adult worms are occasionally visible during subconjunctival migration. A 29-yr-old African female student, living in Korea for the past 5 yr without ever visiting her home country, presented with acute eyelid swelling and a sensation of motion on the left eyeball. Her symptoms started one day earlier and became worse over time. Examination revealed a threadlike worm beneath the left upper bulbar conjunctiva with mild eyelid swelling as well as painless swelling of the right forearm. Upon exposure to slit-lamp illumination, a sudden movement of the worm toward the fornix was noted. After surgical extraction, parasitologic analysis confirmed the worm to be a female adult Loa loa with the vulva at the extreme anterior end. On blood smear, the microfilariae had characteristic features of Loa loa, including sheath and body nuclei up to the tip of the tail. The patient also showed eosinophilia (37%) measuring 4,100/microL. She took ivermectin (200 microg/kg) as a single dose and suffered from a mild fever and chills for one day. This patient, to the best of our knowledge, is the first case of subconjunctival loiasis with Calabar swelling in Korea.

Spontaneous extrusion of subconjunctival cysticercous cyst: a case report

Ocular cystericosis is the common occurrence among the people of lower socioeconomic status and poor personal hygiene in developing countries. However, spontaneous extrusion of subconjuctival cysticercous cyst is a rare incidence. The present case report describes a spontaneous extrusion of subconjunctival cyst in a 12 year old boy in our clinical set-up. The histopathological examination revealed subconjunctival cysticercous cyst. The extrusion was associated with improvement in clinical sign and symptoms. Cysticercosis should be considered in any case of inflammatory swelling of subconjunctival space especially in people of lower socioeconomic status and poor personal hygiene.

Removal of Thelazia Callipaeda from the Subconjunctival Space

Purpose

To report the finding of Thelazia callipaeda within the human subconjunctival space.

Methods

An 81-year-old man with a history of traumatic conjunctival laceration that occurred 2 years previously had white worms in the subconjunctival space of his right eye.

Results

Five worms were removed from the subconjunctival space via a local peritomy, since there was no conjunctival laceration noted during the examination. These worms were identified as T callipaeda.

Conclusions

T callipaeda cannot dig holes in the ocular wall due to the lack of hooks or sharp spines within the mouth. Therefore, the authors speculate that these worms entered the subconjunctival space through a conjunctival laceration that had occurred 2 years previously. (Eur J Ophthalmol 2007; 17: 266–8)

[Human subconjunctival dirofilariasis: two Tunisian case studies]

Two new cases of human subconjunctival dirofilariasis are reported in Tunisia. Dirofilaria immitis was identified in the first case and Dirofilaria repens in the second. Diagnosis was made by histological examination of excised nodules. We note that the patients are young (8 and 10 years, respectively) and that cases of human dirofilariasis caused by Dirofilaria immitis are present in Tunisia.

Oculosporidiosis in a tertiary care hospital of western Orissa, India: A case series

The authors present a case series of 54 subjects of Rhinosporidium. They were reported in two years at a tertiary care hospital of Western Orissa. The clinically diagnosed cases by ophthalmologists were confirmed by histopathological samples following surgery. In our series, we noted Rhinosporidium seeberi organisms as the main causative agent. Males were affected three times more than females. Children less than 10 years of age comprised more than 50% of our series. In 91% of cases, the conjunctiva was the site of this infection. Total excision of fungal mass was carried out in all cases and two cases had recurrence between 9 and 12 months following intervention. Although this is an endemic area for such infestation, unilateral manifestation observed in all cases is interesting to note. Low recurrence rate in limited follow-up period could be due to early detection and standard management.

Unifocal, subconjunctival twin cysticercosis cysts

We report a case of multiple, unifocal, subconjunctival cysticercosis in an 8-year-old boy. Two cysts, each with a scolex, were in the subconjunctival space. They were removed surgically, and histopathologically proven to be Cysticercus cellulosae. This is only the second report of twin cysticercus in the literature, to the best of our knowledge.

Anatomical route of invasion and protective mucosal immunity in Trypanosoma cruzi conjunctival infection

Trypanosoma cruzi is a protozoan parasite that can initiate mucosal infection after conjunctival exposure. The anatomical route of T. cruzi invasion and spread after conjunctival parasite contamination remains poorly characterized. In the present work we have identified the sites of initial invasion and replication after contaminative conjunctival challenges with T. cruzi metacyclic trypomastigotes using a combination of immunohistochemical and real-time PCR confirmatory techniques in 56 mice between 3 and 14 days after challenge. Our results demonstrate that the predominant route of infection involves drainage of parasites through the nasolacrimal duct into the nasal cavity. Initial parasite invasion occurs within the ductal and respiratory epithelia. After successive waves of intracellular replication and cell-to-cell spread, parasites drain via local lymphatic channels to lymph nodes and then disseminate through the blood to distant tissues. This model of conjunctival challenge was used to identify immune responses associated with protection against mucosal infection. Preceding mucosal infection induces mucosal immunity, resulting in at least 50-fold reductions in recoverable tissue parasite DNA in immune mice compared to controls 10 days after conjunctival challenge (P < 0.05). Antigen-specific gamma interferon production by T cells was increased at least 100-fold in cells harvested from immune mice (P < 0.05). Mucosal secretions containing T. cruzi-specific secretory immunoglobulin A harvested from immune mice were shown to protect against mucosal parasite infection (P < 0.05), demonstrating that mucosal antibodies can play a role in T. cruzi immunity. This model provides an important tool for detailed studies of mucosal immunity necessary for the development of mucosal vaccines.

Ocular sparganosis

A 50-year-old male attended outpatients department with complaints of irritation, foreign body sensation and mild redness in his right eye. On examination a conjunctival nodule was found with localised inflammation. All investigations were normal. Surgical excision of the nodule was contemplated. During local dressing a live tapeworm about 20 cm in length and 3 mm in breadth emerged. Pathological examination confirmed it to be a tapeworm spirometra. The case was diagnosed to be ocular sparganosis.

Histopathologically confirmed ocular rhinosporidiosis in two Canadians

CASE REPORT

In India and Southeast Asia, rhinosporidiosis is a common infectious disease, but it has rarely been reported in western countries. Infrequently, isolated ocular rhinosporidial infections have been reported, but to our knowledge, there are no reported cases in Canada. Two cases of rhinosporidiosis have been recently diagnosed and managed at our university-based hospital.

COMMENTS

Rhinosporidiosis presents with certain characteristic clinical features; however, the diagnosis is confirmed histopathologically. The presence of typical sporangia and spores in a fibrovascular stroma infiltrated by acute and chronic inflammatory cells including granulomas is diagnostic. Surgical excision is the treatment of choice, and recurrence is possible but rare.

First report of ophthalmomyaisis externa in Pakistan

Two individuals presented to the Aga Khan University Opthalmology service with foreign-body sensation, pain and redness in one of their eyes. Slit-lamp biomicroscopy revealed tiny larvae crawling around the conjunctival sac. They were mechanically removed under topical anaesthesia and preserved for light microscopy and photography. Comprehensive liaison was established with the Australian Centre for International Agriculture Research for identification of these larvae. Their morphology characterized them as members of fruit-fly, Oestridae family. At least one of them was positively identified as first instar larva of Oestrus ovis. This report describes the first instance of such infections in Southern Pakistan, as concluded after a Medline search.

[Conjunctival dirofilariasis due to Dirofilaria Repens. A new Tunisian case]

INTRODUCTION

Dirofilariasis due to Dirofilaria repens is a parasitic disease affecting domestic animals and transmitted to man by mosquito bites. Human infestation is rare and involves benign subcutaneous and ocular manifestations. The diagnosis is made by excisional biopsy, which is also the sole recommended treatment. There are few reports of human infection in Tunisia.

CASE REPORT

We report herein the second case of conjunctival dirofilariasis in a 21-year-old woman residing in Tunis (Tunisia). The clinical presentation evoked orbital cellulites. Clinical and radiological investigations did not provide a diagnosis. Surgical excision and histological examination established the diagnosis by the presence of an adult female worm identified as Dirofilaria repens. Parasite extraction allowed successful treatment.

CONCLUSION

Dirofilariasis is rare in Tunisia, with only seven cases reported. The true incidence of dirofilariasis is probably greater than recognized. This can be explained by the apparent benign nature of the lesions that may not warrant excision.

[Bulbar subconjunctival tumor secondary to periocular schistosome granuloma]

INTRODUCTION

Schistosomiasis, a parasitic disease, is endemic in many areas in the world. Schistosome eggs can be found in human tissues or organs, including the eye. These eggs can produce inflammatory granuloma. We report a unique and exceptional clinical case of periocular localization of schistosome granuloma.

OBSERVATION

A 12-year-old girl, living in a schistosomiasis-endemic region, presented an inflammatory subconjunctival tumor in one eye. This tumor regressed but did not completely disappear with treatment. Complementary tests showed a slight eosinophilia (500/mm(3)) in the blood and S. mansoni ova in the stools. A biopsy was performed, revealing an inflammatory granuloma with epithelioid and giant cells rich in eosinophilic polynuclear. The immunohistochemical study showed no cells with anti-CD1 and anti-CD30, excluding histocytosis X type lesion.

CONCLUSION

Although considered as exceptional, periocular localization of schistosome granuloma must be proposed, based on epidemiological, clinical and paraclinical results. Schistosomiasis may be considered as an origin of an inflammatory subconjunctival tumor found in endemic areas.

Orbital swelling as a sign of live Dirophilaria repens in subconjunctival tissue

This report presents a case of live dirophilaria found in the subconjunctival space in a woman, in whom the main symptoms were swelling of the orbital tissue. After subconjunctival anaesthesia the dirophilaria were removed surgically. A histopathological examination revealed an adult, non-gravid female Dirofilaria repens s. acutiuscula. To the authors' knowledge this is the first case of subconjunctival live dirophilaria reported in a human.

Case report: ophthalmomyiasis externa in Dallas County, Texas

Ophthalmomyiasis externa is an uncommon condition in North America. If not recognized and managed accordingly, it can be complicated by the potentially fatal condition ophthalmomyiasis interna. Ophthalmomyiasis externa is mainly caused by the sheep bot fly Oestrus ovis; thus, it is more common in farming communities. We report a case of ophthalmomyiasis externa in a young woman from Dallas County, Texas, who had no known history of contact with farm animals.

Orbital and adnexal cysticercosis

Orbital and adnexal cysticercosis is emerging as a far commoner disease than previously considered, both in endemic and nonendemic areas of cysticercosis. A review of the literature on orbital and adnexal cysticercosis found that it has a predilection for children and young adults with no definite sex predilection. The extraocular muscle form is the commonest type of orbital and adnexal cysticercosis. Lodgement of cysts in the subconjunctival space is another common site, followed by the eyelid, optic nerve, retro-orbital space and lacrimal gland. Association of orbital cysticercosis with systemic cysticercosis is quite rare. The clinical manifestations of orbital or adnexal cysticercosis are entirely different and depend on the location, size, relation to adjacent structures and stage of evolution of the cyst. Diagnosis of cysticercosis is based mainly on orbital imaging because of its highly specific appearance. Tissue diagnosis is not essential for initiating treatment. Medical therapy is the recommended treatment for the extraocular muscle form and retro-orbital cysticer-cosis. Surgical removal is advocated for subconjunctival and eyelid cysticercosis. Because of the limited number of cases of optic nerve and lacrimal gland cysticercosis, their treatment is controversial.

Photographic documentation of spontaneous extrusion of a subconjunctival cysticercus cyst

Spontaneous extrusion of a subconjunctival cysticercus cyst is a rare occurrence. The case reported is of a 20-year-old man who presented with a subconjunctival cysticercus cyst that was suspected to be undergoing spontaneous extrusion. The eye was photographed as the parasite extruded through the conjunctival opening with undulating movements over 3-4 min.

Subconjunctival zoonotic onchocerciasis in man: aberrant infection with Onchocerca lupi?

In the past few decades, 10 cases of cryptic, zoonotic onchocerciasis, including two subconjunctival infections, have been reported in man. In the majority of cases, Onchocerca cervicalis, O. gutturosa or O. dewittei, which normally infect horses, cattle and wild boar, respectively, were responsible for the lesions. However, the taxonomic status of the parasites involved in the two subconjunctival infections, both of which were European, has never been unambiguously determined. In such infections, the acute phase appears to be characterized by conjunctivitis. A single, strongly coiled, immature, female worm was found incorporated in a large granulomatous nodule, in the ocular and peri-ocular tissues, in the chronic stage of each of the two eye infections. Several, patent, sporadic cases of subconjunctival O. lupi infection have recently been reported in dogs. In terms of the location of the worms, clinical signs and histopathology, these canine infections were very similar to those seen in the two human patients with eye infection. When the parasites recovered from human eyes were compared morphologically with the Onchocerca spp. infecting animals in Europe, they appeared to be most similar to O. lupi. Although O. lupi is normally a parasite of dogs, it may thus also be responsible for aberrant, zoonotic, subconjunctival infections in man.

Presumed trematode-induced granulomatous anterior uveitis: a newly recognized cause of intraocular inflammation in children from south India

PURPOSE

To describe the epidemiologic, clinical, and histopathologic features of a presumed trematode granulomatous anterior uveitis, primarily in children from south India.

DESIGN

Prospective, noncomparative, case series.

METHODS

Children with clinical evidence of granulomatous anterior uveitis were selected for the study. Those who presented with distinct anterior chamber nodules were evaluated. Demographic details, such as clinical findings and course of illness, were noted. Patients underwent either medical treatment or surgical aspiration of the lesion based on the size of the lesion. Aspirated materials were subjected to histopathologic analysis and cultures for bacteria and fungi. Response to treatment and final visual status were evaluated.

RESULTS

One hundred thirteen patients with anterior chamber nodules were seen between 1998 and 2000. Ninety-three (82.4%) were males and 20 (17.7%) were females. The median age was 11.0 years. All patients were from south India and all gave a history of bathing or swimming in the local pond or river. All had normal systemic work ups. Of the 113 patients, 110 had anterior chamber nodules and three had both anterior chamber and subconjunctival nodules. Aspirates of the anterior chamber lesions revealed lymphocytes, intact and necrotic neutrophils, and eosinophils admixed with histiocytes. One subconjunctival nodule showed necrotizing granuloma, displaying the tegument of a trematode. Those patients who were followed had good visual recovery after medical or surgical intervention or both.

CONCLUSION

The present study shows a newly recognized granulomatous anterior uveitis caused by a presumed water-borne trematode infection. This infection appears to be a common cause of pediatric granulomatous anterior uveitis in south India.

Subconjunctival zoonotic Onchocerca in an Albanian man

A case of subconjunctival infection with a zoonotic species of Onchocerca is described, in a 16-year-old Albanian man who had immigrated to Greece. This is the first report of human infection with Onchocerca in this tissue location and only the eighth report of zoonotic Onchocerca in man.

[Ophthalmomyiasis externa acquired in Germany: case report and review of the literature]

Infestation with larvae (maggots) is known as myiasis. Ophthalmomyiasis externa refers specifically to infestation that involves the lids and conjunctiva in man. Ophthalmomyiasis which originates from Germany is unusual, because the vector of the Oestrus ovis larvae is most prevalent in the warm climate of Mediterranean countries. The sheep nasal botfly (Oestrus ovis sp.) is responsible for most cases of external ophthalmomyiasis. This case report gives a detailed description of the larvae, their life cycle and an overview of infestations in Germany as well as the therapy of ophthalmomyiasis.

CASE REPORT

At the end of August 1999, a 28-year-old man attended the outpatient department of Giessen University Eye Clinic with a foreign body sensation in his left eye. He reported that something hit his left eye while he was climbing on his motorbike in the early evening hours. Shortly afterwards he had a foreign body sensation in his left eye. On history taking he reported no other ophthalmologic problems in the past. Slitlamp biomicroscopy revealed white, vivid, approximately 1.5-mm-long, light-sensitive maggots on the conjunctiva and under the upper lid. These were removed mechanically and the conjunctiva rinsed with saline. Local therapy was not applied.

CONCLUSION

Infestation with larvae of O. ovis has to be considered not only in tourists from Mediterranean countries, but also in Germany in the late summer.

Subconjunctival adult bancroftian filarial worm

We report a case of live adult Bancroftian Filarial nematode removed from the sub conjunctival tissue of a 58-year-old woman from the temporal limbus of her left eye.