Case Report: Three-Day Albendazole Regimen for Orbital Cysticercosis and the Stardust Sign

Ultrasonography findings have been used to diagnose and treat 10 cases of orbital cysticercosis. Although oral prednisolone has a key role in symptomatic alleviation, 3-day albendazole has been demonstrated to be curative without any recurrence.

Angiostrongylus-a technique for removing a rare parasite from the cornea of a child

We report a case of an Angiostrongylus parasite in the corneal stroma in an 8-year-old boy and our technique for its removal. The parasite was identified on slit-lamp examination. Its location was confirmed on anterior segment optical coherence topography (AS-OCT). The parasite was found on the superficial corneal stroma in the periphery and was removed after lamellar dissection of the cornea following marking with trephine.

MOBILE SUBRETINAL CYSTICERCUS IMAGED BY SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY WITH MOTION TRACKER

PURPOSE

To report optical coherence tomography-based videoimaging of alive subretinal cysticercus along with its mobile scolex.

METHODS

Spectral-domain optical coherence tomography was used to record high-definition videoimages, using the inbuilt motion tracker, in a 12-year-old boy with history of neurocysticercosis.

RESULT

The scolex was found to be sensitive to light, and contractile movements were seen in the cyst wall and the germinative layers. The patient underwent vitrectomy, and the diagnoses were confirmed with histopathologic assessment.

CONCLUSION

Optical coherence tomography is a useful tool for diagnosing posterior segment cysticercosis. The intense motion of scolex does not impact the surrounding ocular structures.

Ultrasound Biomicroscopy Findings in Peripheral Vitreoretinal Toxocariasis

Purpose

To describe the morphologic alterations in ultrasound biomicroscopy (UBM) present in peripheral vitreoretinal toxocariasis.

METHODS

An observational prospective study of case series. Fifteen eyes of 15 patients with clinical and laboratory diagnosis of peripheral vitreoretinal toxocariasis were enrolled. The patients were submitted to UBM examination of the region corresponding to the pars plana of the affected eye.

Results

The most common morphologic alterations found by UBM in patients with peripheral vitreoretinal toxocariasis were as follows: vitreal membranes (13 cases), toxocara granuloma (11 cases), and pseudocysts (8 cases). Other less frequent findings were thickening of the ciliary body (6 cases), cystic formation (2 cases), peripheral retinal detachment (2 cases), rectification of the iris root (1 case), and posterior synechiae (1 case).

CONCLUSIONS

UBM allows detection of well-defined morphologic alterations associated with peripheral vitreoretinal toxocariasis, being useful to reinforce the clinical diagnosis

Surgical Excision of Orbital Cysticercosis Lodged in Superior Oblique Muscle: Clinical Case Report

Ocular cysticercosis refers to parasitic infections in humans. Most cases were treated by medicine. The case we reviewed was rarely reported with successful surgical intervention treatment.This case report describes a patient with cysticercosis existing in superior oblique tendon. The main symptom of the patient was recurring history of painless orbital swelling and double vision in upgaze. Ocular motility examination revealed a restriction of the right eye in levoelevation. A contrast-enhanced computed tomographic scan of the orbit revealed the presence of a well-defined hypodense cystic lesion within the right superior oblique muscle.The patient was diagnosed with orbital space-occupying mass with acquired Brown syndrome. Surgical exploration of the superior oblique muscle was performed, and the cyst was removed from the eye and confirmed by histopathological examination. After surgery, an ocular motility examination revealed orthotropia in the primary position and downgaze, with mild restriction in levoelevation.Surgical removal could substitute for medical therapy when the cysticercosis is lodged in the superior oblique muscle, although, prior to surgery, important factors, such as patient requirements, surgical skills of the surgeon, and cyst placement, should be considered.

Orbital myiasis complicating squamous cell carcinoma in xeroderma pigmentosum

Ophthalmomyiasis is a rare infection seen in susceptible individuals. We report a case of orbital myiasis in squamous cell carcinoma (SCC) in a patient of xeroderma pigmentosum. On presentation, reddish brown ulcerated mass with numerous maggots in orbit were seen. Computed tomography scan showed the presence of soft tissue lesion without any bony destruction. Following debridement, emergency exenteration with sacrifice of eyelid skin was performed. The diagnosis of SCC was confirmed on histopathologic evaluation. The maggots belonged to family Calliphoridae and secondary bacterial infection with Klebsiella organism was identified. Management issues included extensive involvement requiring exenteration, non-availability of skin graft, delayed secondary healing and recurrence of pigmented lesions in skin lining of orbit. The skin grafting was avoided as it can harbour the neoplasm.

Two different presentations of orbital echinococcosis: a report of two cases and review of the literature

PURPOSE

To report two patients with different presentations of orbital echinococcosis, namely hydatid and alveolar cysts and to compare their clinical, imaging and histopathologic findings and treatment.

METHODS

This retrospective study includes two young rural children who were referred because of progressive proptosis.

RESULTS

Orbital imaging in both cases revealed cystic intraorbital lesions. With a clinical suspicion of hydatid and alveolar cysts, both patients underwent intact surgical excision. Histopathologic evaluation confirmed the diagnoses.

CONCLUSIONS

Clinical findings and imaging can help in the preoperative diagnosis of patients with orbital echinococcosis. Knowledge of the nature of cystic orbital lesions is important in preventing complications. Alveolar cysts are more invasive than hydatid cysts and their treatment is more complicated.

Taenia coenurus in the orbit of a chinchilla

A 4-year old, male intact, captive-bred chinchilla (Chinchilla lanigera) was presented due to progressive exophthalmos of the right eye over a 5-month period. Ophthalmic examination revealed exophthalmos with dorsal displacement of the right globe. Retropulsion was decreased and a fluctuant, subcutaneous mass could be palpated posterior and dorsal to the central aspect of the zygomatic bone. Transdermal ultrasonography revealed a fluid-filled mass consistent with a cyst located within the ventral right orbit. Computed tomography demonstrated dorsal displacement of the globe, lateral displacement of the zygomatic arch, and numerous mineral-dense foci within the lumen of the cyst. The cyst was removed en bloc by ventral transpalpebral orbitotomy. Histopathology revealed a single capsulated cyst with multiple invaginated protoscolices, characterized by a prominent scolex with refractile hooklets, suckers, and abundant calcareous corpuscles consistent with a Taenia coenurus. Exophthalmos resolved with surgical therapy and there was no evidence of recurrence or postoperative complications over a period of 2 years. To the authors' knowledge, this is the first reported case of an orbital cyst of parasitic origin in a chinchilla.

Orbital hydatid cyst manifested as expanding exophthalmos following blunt orbital trauma

A 14-year-old boy suffered right blunt orbital trauma. X-ray revealed a compressed fracture of the right ethmoidal sinuses. Three months after the trauma, progressive, painless right proptosis developed. Ocular examination revealed a severe proptosis and pronounced down displacement of the right globe without signs of orbital inflammation. A well-demarcated, extraconal right orbital cystic mass was seen on computerized tomography scan. The cyst contents were aspirated and found to contain echinococcal scolices and "hydatid sand." Hypertonic saline was injected and the cyst was excised. Progressive proptosis after blunt orbital trauma in patients from endemic areas should be suspected of being an orbital hydatid cyst.

Fasciola hepatica in the human eye

During intraocular surgery of a 44-year-old woman from Guilan Province in north Iran, a small flat parasite was removed from the anterior chamber angle of the left eye. According to morphological characterisation of the parasite, it was identified as Fasciola hepatica. The route of entry of the parasite was not identified. Meanwhile, stool and serology examinations of the patient for diagnosis of Fasciola infection were negative. In endemic areas of F. hepatica infection, ocular involvement should be considered in cases of uveitis, despite no other systemic involvement.

Polycystic echinococcosis of the orbit

PURPOSE

To report a case of polycystic echinococcosis of the orbit caused by Echinococcus oligarthrus.

DESIGN

Interventional case report.

METHODS

A 14-year-old girl presented with a massive proptosis of the right eye of 9 years duration and loss of vision. The eye was phthisic, and a cystic mass was palpable. Computed tomography scan showed closely packed multiple orbital cysts with destruction of the medial orbital wall. Surgical exploration was performed.

RESULTS

The phthisic eye was enucleated. Dissection of the outer fibrous capsule yielded approximately 30 intact translucent white cysts of various sizes that were suggestive of polycystic echinococcosis. The diagnosis of echinococcosis was confirmed on histopathologic evaluation. The specific diagnosis of E oligarthrus was made on the basis of the presence of straight-backed hooks and central guards.

CONCLUSION

Polycystic echinococcosis of the orbit caused by E oligarthrus is rare. It may be an entirely new entity or hitherto unrecognized form of orbital echinococcosis.

Atypical presentations of orbital cysticercosis

We describe three patients with orbital cysticercosis who presented with atypical clinical or radiologic features previously unreported. All three patients had a cyst with a scolex on imaging studies. After 6 weeks of treatment, all three had almost complete resolution of their features.

Ultrasound biomicroscopy in the diagnosis and management of intraocular gnathostomiasis

PURPOSE

To describe the use of ultrasound biomicroscopy in the identification of an intraocular nematode in a case of suspected nematode-induced uveitis

DESIGN

Observational case report.

METHOD

UBM was performed under topical anesthesia in a patient with acute painful uveitis suspected to result from an intraocular nematode. Clinical examination did not reveal the nematode.

RESULTS

Over a 6-minute time span, serial UBM examinations revealed the nematode to move from the iris root into the posterior chamber through the zonules. Subsequently, it was seen adhering to the cornea and could be removed surgically, resulting in symptom relief.

CONCLUSION

UBM is a useful tool in diagnosis and management of parasitic uveitis.

Eyelid sparganosis

PURPOSE

To report a case of sparganosis in the muscle layer of the eyelid.

DESIGN

Observational case report.

METHODS

A 67-year-old man with migratory painful swelling on the eyelid that was unresponsive to medications was evaluated and treated surgically.

RESULTS

Computed tomography showed a 1.5 x 1.5-cm sized, thick-walled lesion and ultrasound biomicroscopy showed hypoechoic tubular and cystic lesions. During surgery, a white, thread-like plerocercoid, 7 cm in length was detected in the orbicularis muscle of the lower eyelid. Histopathologic examination demonstrated the characteristic feature of the sparganum larva and foreign body granulomatous reaction. Serodiagnosis by enzyme-linked immunosorbent assay was positive. Three months postoperatively, the lesion resolved completely.

CONCLUSION

Although rare, sparganosis should be suspected in a moving eyelid mass unresponsive to the medical treatment.

Orbital cysticercosis-associated scleral indentation presenting with pseudo-retinal detachment

PURPOSE

To report a clinical picture similar to retinal detachment caused by orbital myocysticercosis-associated scleral indentation.

DESIGN

Interventional case series.

METHODS

Of the 49 cases of orbital myocysticercosis, four eyes of four patients had pseudoretinal detachment presentations that are detailed.

RESULTS

Of the four patients with pseudoretinal detachment, three were found to have orbital myocysticerci in lateral and one in inferior recti muscles, mechanically indenting the eyeball, causing scleral indentation, evidenced by ultrasonography or computed tomography. Associated signs of myocysticercosis were orbital inflammation, restricted ocular motility or proptosis. In 2 to 10 days, the cysts traveled forward and came to lie in a sub-Tenon position. Three cysts were removed surgically and one extruded spontaneously.

CONCLUSIONS

Patients presenting with a clinical picture similar to retinal detachment in the presence of symptoms and signs of orbital cysticercosis, with a history of exposure to an endemic area, should be considered to have orbital myocysticerci causing scleral indentation.

Bilateral, multifocal orbital cysticercosis

Orbital cysticercosis is a benign infection with a variety of clinical presentations. Awareness of all of the possible clinical manifestations could aid early diagnosis and prevention of late sequelae. We report a case of bilateral, multifocal, intraconal orbital cysticercosis, which is an extremely rare presentation.

Ultrasound findings in orbital hydatid cysts

PURPOSE

To describe the ultrasound features seen in orbital hydatid disease, which may confirm the diagnosis preoperatively.

DESIGN

Interventional case series.

METHODS

Nine patients of orbital hydatid cyst were evaluated preoperatively with ultrasound and computed tomography scans. The diagnostic features seen on ultrasound as well as the CT features are described. All patients underwent surgery to remove the cyst, and the diagnosis was confirmed surgically in all nine cases.

RESULTS

We found that ultrasound was most helpful in diagnosing a hydatid cyst, even more so than a computed tomography scan, and we saw a diagnostic "double wall" sign in all cases, on ultrasound, a sign not previously described in orbital hydatids.

CONCLUSIONS

It is difficult to diagnose an orbital hydatid cyst preoperatively. However, we found that the double wall sign could be elicited ultrasonically in all cases of hydatid cyst, if looked for carefully, and the diagnosis could be confirmed.

CT in the diagnosis of isolated cysticercal infestation of extraocular muscle

AIM

To evaluate the use of computed tomography (CT) and ultrasound (US) to diagnose orbital cysticercosis, and present the diagnostic features.

METHOD

US and CT were used to evaluate patients with proptosis. Four patients were diagnosed as having orbital myocysticercosis and treated with oral albendazole and corticosteroid. Follow-up was undertaken with US and CT.

RESULT

US features were confirmatory of myocysticercosis in two eyes where as CT was effective in diagnosing the condition in all four eyes. In two patients the medial rectus was involved, in one the superior rectus and, in the other, the inferior rectus muscles. Serial US and CT revealed complete resolution of the lesions in 3 months.

CONCLUSION

CT is useful method in diagnosing isolated orbital myocysticercosis. Our report demonstrated that ophthalmic signs and symptoms in the presence of proptosis, especially in an endemic region, should alert the clinician to the possibility of myocysticercosis. Though CT is superior, US can be used as a economical follow-up investigation.

Magnetic resonance imaging in the diagnosis of subretinal cysticercosis

PURPOSE

To report a case of ocular cysticercosis and associated magnetic resonance imaging (MRI) findings.

DESIGN

Interventional case report.

METHODS

A 56-year-old woman from Ecuador presented with decreased vision and an exudative retinal detachment in the left eye. Subretinal cysticercosis was suspected.

RESULTS

In the left eye, a subretinal cyst evident on fundus examination was investigated with B-scan ultrasonography. Ultrasonography showed a cystic structure, and MRI of the orbit confirmed the suspicion for cysticercosis. Magnetic resonance imaging of the brain also revealed a small parenchymal lesion in the left occipital lobe of the brain.

CONCLUSIONS

Magnetic resonance imaging is a useful adjunct to B-scan ultrasonography in the diagnosis of ocular cysticercosis. Magnetic resonance imaging is superior to computed tomography in the demonstration of cystic structures in the eye and central nervous system. This finding has important therapeutic implications, as any viable cysticercus in the eye or cerebral parenchyma can be treated surgically or medically, respectively.

Orbital dirofilariasis

Dirofilariasis is a parasitic disease of domestic and wild animals that occasionally may present as zoonotic infection in humans. The microfilariae are accidentally transmitted to humans by Culex and Aedes mosquitoes. Ophthalmic infections with Dirofilaria are well documented all over the world, including America, Europe and Australia. The infection may be periorbital, subconjunctival or intraocular. In this report a case is described of orbital dirofilariasis that presented as ptosis and lid swelling. Australian ophthalmologists should consider dirofilariasis as part of the differential diagnosis of orbital swelling and inflammation.

Optic nerve cysticercosis

Cysticercosis of the optic nerve is an extremely rare entity and only seven cases have been reported in the world literature. A case of optic nerve cysticercosis in a 25-year-old woman is reported, along with a review of literature. The patient presented with two episodes of pain, diminution of vision and proptosis. Computed tomography and ultrasonography revealed an intraneural cyst with scolex in the retrobulbar portion of the optic nerve. A positive enzyme-linked immunosorbent assay test for cysticercosis further confirmed the diagnosis. Medical therapy in the form of oral albendazole and steroids resulted in complete resolution of the cyst, with few visual sequelae.

Extraocular muscle cysticercosis presenting as Brown syndrome

PURPOSE

Report of a case of acquired Brown syndrome caused by infestation of the superior oblique muscle by Cysticercus cellulosae.

METHOD

Case seen in a referral practice. A 20-year-old man presented with recurrent attacks of conjunctivitis and diplopia in upgaze. Clinical examination of ocular motility established a diagnosis of acquired Brown syndrome of the right eye. Computed tomography of the right orbit unequivocally established the diagnosis of superior oblique muscle cysticercosis. The patient was started on systemic steroids and albendazole in the prescribed doses for a month.

RESULT

Serial computed tomography scans of the orbit revealed resolution of the cystic lesion after a month. Clinically, although there was restoration of ocular motility in upgaze, mild restriction of movement of the right eye in levoelevation persisted. However, the patient was symptomatically better with amelioration of the recurrent conjunctivitis and diplopia in primary gaze.

CONCLUSION

Extraocular muscle cysticercosis should be considered in the differential diagnosis of acquired motility disorder. The presentation of extraocular muscle cysticercosis as an acquired Brown syndrome is unusual. Response to medical therapy was satisfactory.

Value of high-frequency ultrasound biomicroscopy in uveitis

PURPOSE

To determine the use of high-frequency ultrasound biomicroscopy (UBM) in the assessment of inflammatory lesions of the iris, ciliary body, pars plana and peripheral vitreous, and in particular to determine the proportion of cases for which UBM contributed significant additional, hitherto inaccessible, information.

METHODS

Charts of patients seen in the uveitis clinic at University Eye Hospital from November 1994 to September 1999 for whom a UBM investigation had been performed were analysed. UBM was performed in a standard manner, using a Humphrey UBM 840 system. The clinical relevance of the UBM findings was determined for the whole series and for the following six subgroups of patients arbitrarily established according to the type and location of pathology: hypotony, pseudophakic uveitis, iris and ciliary body pathology excluding hypotony, pars plana pathology, scleritis and Toxocara uveitis. Findings were classified as positive when they confirmed a suspected diagnosis of lesional process or when they gave essential information. Findings were classified as essential when they led to the diagnosis or when they modified therapeutic intervention.

RESULTS

During the study period 111 eyes of 77 patients were included. UBM findings contributed essential information that allowed a diagnosis to be reached or that influenced treatment in 43% of cases. It yielded positive findings in 91% of cases, enabling assessment of morphological changes in the iris, ciliary body, and retroiridal and peripheral vitreous induced by intraocular inflammatory or pseudo-inflammatory disorders. Specific UBM signs, present in all patients, were identified in Toxocara uveitis. The groups of patients that benefited most from UBM examination were those with hypotony (83% essential findings) and opaque media (100% essential findings).

CONCLUSION

For uveitis patients with an inflammatory process situated in the iris/ciliary body/pars plana/retroiridal vitreous areas, UBM was of great clinical value and improved the management in a significant manner.

Albendazole therapy for a recurrent orbital hydatid cyst

Till recently, the treatment of a multiloculated hydatid cyst in the confines of the orbit was every ophthalmologist's nightmare. Over the last decade, two benzimidazole compounds, mebendazole and albendazole, have been tested clinically for use in the chemotherapy of hydatid disease.

Subcutaneous cysticercosis involving the eyelid: sonographic diagnosis

A 25-year-old man and a 14-year-old boy presented with neurocutaneous cysticercosis involving the eyelid. Both patients had hundreds of scattered subcutaneous cysticerci. They were arranged in clusters over the sternocleidomastoid muscle in the neck. Such clustering of cysticerci is highly suggestive of central nervous system (CNS) involvement, as both the sternocleidomastoid muscle and the CNS are supplied by the carotid artery and cysticerci travel via the hematogenous route. We used ultrasonography to diagnose subcutaneous cysticercosis, which showed characteristic low reflective cysts and high reflective scolices inside. Although subcutaneous cysticerci are inconsequential, their verification is important in the diagnosis of more severe CNS involvement. They may be confused with other painless swellings such as lymphadenopathies, neurofibromas, and epidermoid cysts.

Ultrasound biomicroscopy in peripheral retinovitreal toxocariasis

PURPOSE

To report ultrasound biomicroscopic features in peripheral retinovitreal Toxocara uveitis.

METHODS

Three patients with unilateral vitreitis suspected to be caused by peripheral toxocariasis were referred for ultrasound biomicroscopic examination of the peripheral retina, pars plana, and adjacent vitreous.

RESULTS

In two of the three patients, characteristic pseudocystic transformation of the peripheral vitreous was seen. In both patients, Toxocara serology was positive and eosinophilia was present. In the third patient, no pseudocystic transformation of the peripheral vitreous was seen; however, there was the dense thickening adjacent to the pars plana usually seen by ultrasound biomicroscopy in pars planitis and corresponding to clinically visible snowbanks. The third patient had a negative Toxocara serology and later developed bilateral intermediate uveitis of the pars planitis type. In none of 48 patients with diverse inflammatory conditions of the retroiridal space that were examined by ultrasound biomicroscopy were the characteristic Toxocara-associated pseudocystic images seen.

CONCLUSIONS

Pseudocystic transformation of the peripheral vitreous appears to be a rather specific and sensitive ultrasound biomicroscopic sign in patients with presumed peripheral toxocariasis that will likely aid diagnosis in difficult cases.

[Hydatid orbital cyst: a unique intra-orbital locality. A case report]

Orbital hydatidosis is uncommon, accounting for 1 to 2% of all localizations. It is caused by Echinococcus granulosis, a dog parasite tapeworm. We report an intra-orbital hydatid cyst observed in a five-year-old boy, presenting the main features of this unusual localization. Hydatid cyst should be evoked in case of tumorous exophthalmia in young patients, especially in children having lived in endemic zones. The preoperative diagnosis is based on clinical findings and ultrasonographic, computed tomographic and magnetic resonance imaging findings. The fronto-orbital approach is most commonly used for treatment. Infectious and functional prognosis depends on early surgery.

Medical management of orbital myocysticercosis: a pilot study

PURPOSE

To evaluate the efficacy of albendazole in the management of orbital myocysticercosis.

METHOD

Twenty-one consecutive patients diagnosed as having orbital myocysticercosis by ultrasonography, supported by computed tomography (CT)/magnetic resonance imaging (MRI), were included in the study. All patients received oral albendazole at a dosage of 30 mg/kg for 15 days with a low-dose steroid cover (5-10 mg per day). The patients were followed on day 2 at 2 weeks, 1 month, 3 months, 6 months and 9 months, and finally at 1 year. Orbital sonography was performed at 2 weeks, 3 months, 6 months, 9 months and 1 year. CT scan was performed at 6 months and 1 year.

RESULTS

Orbital sonography revealed a well-defined cystic lesion with clear contents and a hyperechoic area suggestive of a scolex in all the patients. CT or MRI provided additional supportive evidence. The size of the cysts measured before treatment ranged from 6.2 to 13.4 mm (mean 11.4 mm). Medial rectus was involved in 10 cases, superior rectus in 7 cases and lateral rectus in 4 cases. Serial ultrasonography revealed a gradual reduction in the cyst size in 20 patients. A mild obscuration of the cyst wall, followed by collapse of the cyst cavity and obscuration of the scolex, were progressively seen as the cyst reduced in size. Complete resolution of the cyst was seen in all cases at 6 months. A CT scan performed at 1 year supported the ultrasonographic findings. No systemic side effects were noted.

CONCLUSION

Oral albendazole appears to be highly efficacious in the management of orbital myocysticercosis.

Experimental intravitreous cysticercosis

BACKGROUND

Cysticercosis is one of the parasitic diseases that most frequently affects the eye. The most common and severe manifestations of ocular infection are secondary to posterior segment involvement, which often leads to blindness and atrophy of the eye. The pathogenesis of ocular injury in this disease is poorly understood. The authors have developed an experimental animal model for intravitreous cysticercosis using New Zealand rabbits and Taenia crassiceps cysticerci.

METHODS

Twelve rabbits were divided into two groups. Rabbits in group I were inoculated with one living cysticercus in the vitreous cavity. Rabbits in group II received an intramuscular dose of steroids prior to inoculation of parasites.

RESULTS

An intense inflammatory reaction, which lead to a severe ocular injury, was observed in rabbits of group I, while rabbits in group II had minimal inflammatory changes. Histopathological studies showed a severe histiocytic infiltrate with generalized retinal damage in group I, and a mild inflammatory infiltrate, limited to the area of direct contact with the parasite in group II. The ocular lesions found in rabbits which did not receive steroids (group I) resembled those found in human ocular cysticercosis.

CONCLUSION

These observations indicate that ocular damage in this parasitic disease might be directly related to inflammatory changes produced by the presence of cysticerci. This model appears to be useful for future investigations.

Socio-demographic trends in ocular cysticercosis

There has been a gradual change in the socio-demographic trends of ocular/adnexal cysticerosis. We present the results of a 5-year study of 33 cases of ocular/adnexal cysticercosis and compare our observations with those reported by previous authors. The male:female ratio in our study was 2:1 and maximum number of patients (45%) belonged to the age-group of 31-40 years. Seventy percent of our patients were of low socio-economic status and 70% were strictly vegetarians. The most common location of cysticerci was in the vitreous (50% of all cases); orbital cysts were present in 5% and subconjunctival cyst in 3%. Most common extraocular site for associated cysticercosis was the brain (18%): Ultrasonography proved to be an effective and economical alternative to magnetic resonance imaging and computerized tomographic scanning for the detection of cysticerci in the orbit and in eyes with hazy media.

Differential diagnosis of leukokoria: radiologic-pathologic correlation

Leukokoria is an abnormal pupillary light reflection that usually results from an intraocular abnormality and is seen most often in children. One-half of the cases of childhood leukokoria are caused by retinoblastoma, a malignant tumor of immature retinoblasts that manifests in a normal-sized eye as a calcified mass, is often partially necrotic, and grows into the vitreous and through the choroid. Retinoblastoma enhances with contrast material and, unlike most tumors, may be darker than vitreous on T2-weighted images. When leukokoria is associated with microphthalmia, persistent hyperplastic primary vitreous (PHPV) (28% of cases) or retinopathy of prematurity (ROP) (5% of cases) should be considered. PHPV is a congenital, usually unilateral lesion that appears as a dense tubular mass extending from the lens to the retina along the course of the hyaloid canal. Hemorrhage from PHPV produces a subhyaloid (or subretinal) fluid collection, often with characteristic blood-fluid levels. ROP is bilateral and usually manifests in premature infants who received supplemental oxygen therapy. Coats disease (16% of leukokoria) is a sporadic unilateral idiopathic retinal telangiectasia that produces a lipoproteinaceous subretinal exudate leading to complete retinal detachment. The globe has normal size but increased attenuation and signal intensity from hemorrhage without calcification or enhancement. Toxocaral endophthalmitis (16% of leukokoria) is a granulomatous reaction to the parasite in the vitreous and uveoretinal coat. Retinal astrocytoma (3% of leukokoria), which manifests in a normal-sized globe, is an indolent benign neoplasm commonly associated with phakomatoses (usually tuberous sclerosis).

A primary intraocular hydatid cyst

Ultrasonography and computerized tomography (CT) of the painful and blind right eye of a 13-year-old girl showed a cystic mass almost filling the vitreous cavity and narrowing the anterior chamber. The histopathologic diagnosis of the enucleated eye was an echinococcus cyst. Abdominal ultrasonography, brain CT and chest X-rays gave no abnormal findings when first examined, nor during the follow-up 18 months after surgery. Indirect hemagglutination test was negative at the last control. The case was accepted as a primary hydatid cyst (echinococcosis) of the eyeball.

Echographic characteristics of ocular toxocariasis

Ocular toxocariasis most commonly presents as one of three distinct clinical syndromes: endophthalmitis, localized posterior granuloma, or peripheral granuloma. Using standardized echography, the authors studied 11 toxocariasis patients presenting with one of these syndromes. Common echographic findings were noted in ten of these patients, and included: (1) a solid, high-reflective peripheral mass, (2) a vitreous band or membranes extending between the posterior pole and the mass, and (3) a traction retinal detachment or fold from the posterior pole to the mass. These findings were present in patients presenting with leukocoria or endophthalmitis, as well as in patients in whom the peripheral nematode lesion could be visualized clinically. In combination with the history, clinical examination, and enzyme-linked immunosorbent assay (ELISA), standardized echography may be useful in establishing the diagnosis of ocular toxocariasis in cases of leukocoria in which nematode endophthalmitis is suspected.

[Ultrasonic diagnosis of intraocular cysticercus]

Intraocular cysticerci are mostly located in the subretinal space or vitreous. When the fundus is obscured by exudate or hemorrhage, the diagnosis becomes very difficult with the ophthalmoscope or biomicroscope. The authors performed A- and B-scan echographic studies on 20 cases of intraocular cysticercus during February 1985 to December 1988; it was found that B-scan was very useful in diagnosing intraocular cysticercus with regard to its location and relation to surrounding tissues. Several cases with typical echograms are presented with discussions. The ultrasonic diagnoses were confirmed by surgery.