|Year : 2020 | Volume
| Issue : 1 | Page : 4
Pearl of the eye…ocular cysticercosis
Neha Verma, Ashish Kumar Ahuja
Department of Ophthalmology, Sant Parmanand Hospital, New Delhi, India
|Date of Submission||21-Dec-2019|
|Date of Acceptance||23-Dec-2019|
|Date of Web Publication||23-Jan-2020|
Dr. Neha Verma
Sant Parmanand Hospital, 18 Sham Nath Marg, Civil Lines, New Delhi - 110 054
Source of Support: None, Conflict of Interest: None
We present a case of an 18-year old female with intraocular cysticercosis in the form of a freely mobile cyst in the anterior chamber of the right eye,that was successfully removed by viscoexpression.
Keywords: Cysticercus cellulosae cyst, intraocular cysticercosis, viscoexpression
|How to cite this article:|
Verma N, Ahuja AK. Pearl of the eye…ocular cysticercosis. Pan Am J Ophthalmol 2020;2:4
| Introduction|| |
Cysticercosis is a serious public health problem in developing countries. Caused by pork tapeworm (Taenia solium), humans are infested as intermediate hosts and pigs are infested as definitive hosts in the life cycle. The cysts can lodge in various body tissues including central nervous system, eyes, and subcutaneous tissues, causing compressive or inflammatory symptoms.
Ocular cysticercosis, though rare, can be extraocular (subconjunctival, in orbital tissues) or intraocular (vitreous, subretinal space, or anterior chamber).
| Case Report|| |
We report an 18-year-old female who presented to us with the complaint of a whitish mobile lesion in her right eye for 12 days. She noted that the lesion was gradually increasing in size, but there was no association with any pain, redness, or watering. There was no history of a decrease in vision or any double vision and no ocular or systemic illness.
Examination revealed a large, live, free-floating cyst in the anterior chamber, showing characteristic undulating movements, the scolex making pendulous movements [Figure 1]. No attachment of the cyst was found to the cornea, iris, or lens capsule. The eye was quiet with a clear cornea and anterior chamber and a visual acuity of 6/6 in both the eyes.
|Figure 1: Cysticercus cellulosae cyst in the anterior chamber of the right eye|
Click here to view
A posterior-segment evaluation revealed no abnormality in the vitreous or retina. Hemogram and stool examination were normal. Computed tomographic scan of the brain was also unremarkable. However, magnetic resonance imaging brain confirmed the presence of numerous cysticercus cellulosae, pointing toward the diagnosis of intraocular cysticercosis.
Surgical removal was planned under cover of oral steroid and oral albendazole. 2% topical pilocarpine was also started in the right eye preoperatively. A limbal incision was made inferotemporally and a clear corneal incision superiorly in the right eye. A glide was inserted through the superior incision so as to cover the pupil and methylcellulose injected simultaneously through the inferotemporal limbal incision. Gentle pressure applied over the posterior lip of the superior incision resulted in the extrusion of the cyst in toto. The anterior chamber was washed thoroughly and incision sites sealed.
Histopathological examination confirmed it to be cysticercus cellulosae. Systemic steroid was gradually tapered, while topical antibiotic steroid combination and oral albendazole were given for a month after surgery.
| Discussion|| |
Ocular cysticercosis is a rare clinical entitiy., Finding it in the anterior chamber is all the more rare. Possible mechanism for its presence in the anterior chamber could be a forward migration of the parasite from the posterior ciliary arteries.,
Surgical removal of the parasite is the treatment of choice. The different modalities of surgical removal of anterior-chamber cysticercus include paracentesis, extraction with forceps, cryoextraction, erysiphake extraction, and viscoexpression. Injection of the viscoelastic in the required superior direction through an inferior opening and introduction of a glide so as to prevent cyst displacement into the vitreous cavity, ensures a safe method of cyst removal in toto.
Declaration of patient consent
The authors certify that they have obtained informed patient consent. In the form, the patient has given her consent for her image and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Cano MR. Ocular cysticercosis. In: Schachat AP, Murphy RB, Patz A, editors. Retina. Vol. 2. St. Louis: CV Mosby Co.; 1989.
Duke-Elder S. Diseases of the uveal tract. In: System of Ophthalmology. Vol. 2. St. Louis: CV Mosby Co.; 1966.
Kapoor S, Sood GC, Aurora AL, Sood M. Ocular cysticercosis. Report of a free floating cysticersus in the anterior chamber. Acta Ophthalmol (Copenh) 1977;55:927-30.
Aracena T, Roca FP. Macular and peripheral subretinal cysticercosis. Ann Ophthalmol 1981;13:1265-7.
Bartholowmew RS. Subretinal cysticercosis. Am J Ophthalmol 1975;79:670-3.
Beri S, Vajpayee RB, Dhingra N, Ghose S. Managing anterior chamber cysticercosis by viscoexpression: a new surgical technique. Arch Ophthalmol 1994;112:1279-80.