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A CASE REPORT OF EXTERNAL OPHTHALMOMYIASIS A RARE ENTITY.

Byline: Muhammad Kashif Hanif, Qamar ul Islam and Uzma Ansari

Article

INTRODUCTION

Myiasis is the infestation of tissues or organs of animals or man by fly larva1. The common sites are skin wounds. Eyes, nose, nasal sinuses, throat, and urogenital tract are rare sites. Ocular involvement occurs in about less than 5% of all cases of human myiasis2. Oestrus ovis is the most common cause of ophthalmomyiasis externa worldwide3.

The severity of myiasis depends on the location of the infestation. External ophthalmomyiasis is mostly benign and self limiting. However, in cases of internal ophthalmomyiasis caused by larvae from other species such as Hypoderma, the larvae can penetrate the sclera and burrow into subretinal space leading to iridocyclitis, endophthalmitis or loss of vision4. Ocular myiasis is more frequent in tropical than temperate regions5.

This is a case report of unilateral larval conjunctivitis refractory to routine standard treatment of conjunctivitis given by medical officer. Work up confirmed the diagnosis and treatment included mechanical removal of two larvae and antibiotic steroid combination along with sunglasses.

CASE REPORT

A 38 year old man reported to Ophthalmology Department CMH Mangla with watering, redness, foreign body sensation, swelling of lids associated with severe discomfort in right eye for last three days. He was sitting under a mango tree in a village field when he felt something had fallen in his eye from the tree. Ocular examination of right eye revealed visual acuity 6/6, swollen lids, hyperemic and congested conjunctiva (fig. 1).

Slit-lamp examination revealed two translucent mobile larvae over the conjunctiva; macroscopic evaluation noted that they were 1-2 mm in length. Initially the eye was irrigated with sterile normal saline but larvae remained hidden under conjunctival layers. Then the larvae were removed using forceps under topical anesthesia. Microscopic examination revealed the sheep nasal bot fly larva. Eye deptt of this hospital did not have the facility of anterior segment photography so pictures of larvae couldnot be taken. Examination of left eye revealed no abnormality. The patient was treated with mechanical removal of two larvae along with antibiotic steroid combination and sunglasses for one week (fig. 2).

DISCUSSION

Ophthalmyiaisis is generally caused by sheep botflies and flesh flies6. Myiasis is predisposed by rural background, crowded conditions and poor personal hygiene in debilitated patients7. Larva with invading habits cause orbital and internal ophthalmic manifestation leading to destructive ophthalmic manifestation. External ophthalmic myiasis refers to superficial infestation of ocular tissue including conjunctiva8. Apart from location, exposure by way of occupation is also a risk factor. Shepherds are at greatest risk for Oestrus ovis infections and horse groomers are at risk for Gastrophilus spp. Infection9.

Treatment is based on removal of the larva (up to 60 larvae have been removed at any one time) followed by topical antibiotics, steroids and local analgesia10.

The present case highlights that irrigation of the conjunctiva with normal saline is unsuccessful in washing out the larvae because the larvae grab the conjunctiva firmly with the help of a pair of oral hooks and numerous hooks on each segment. Therefore, after anesthetizing the conjunctiva, a thorough examination of the eye under magnification and prompt removal of the larvae manually with sterile cotton swab sticks or with forceps should be done to avoid disastrous complications of internal ophthalmomyiasis.

CONCLUSIONS

Early diagnosis with good history taking, keen slit lamp ocular examination with high index of suspicion of ophthalmomyiasis in mind and prompt treatment is recommended in such cases to prevent serious complications.

Early diagnosis with good history taking, keen slit lamp ocular examination with high index of suspicion of ophthalmomyiasis in mind and prompt treatment is recommended in such cases to prevent serious complications.

Reference

1. Abdelhameed AA. External Ophthalmomyiasis due to Oestrus Ovis: A Case Report from Oman.Oman Med J.2010 October; 25(4).

2. Anita P, Molly M, Ashish KA, Anupam D,Sandeep K, and Kirti J.External Ophthalmomyiasis Caused by Oestrus ovis: A Rare Case Report from India.Korean J Parasitol. 2009 March; 47(1): 57-59.Published online 2009 March 12.

3. Sreejith RS, Reddy AK, Ganeshpuri SS, Garg P. Oestrus ovis ophthalmomyiasis with keratitis. Indian J Med Microbiol 2010;28:399-402

4. Manal Z. M. Abdellatif, Hesham M. F. Elmazar,1 and Amna BE ovis as a Cause of Red Eye in Aljabal Algharbi, Libya Middle East Afr J Ophthalmol. 2011 Oct-Dec; 18(4): 305-308.

5. Kamlesh T, Gagandeep S,Smriti C, and Anuradha S.External ophthalmomyiasis infection that occurred, and was diagnosed and treated in a single day: A rare case report Oman J Ophthalmol. 2009 Sep-Dec; 2(3): 130-132.

6. Shubhangi N. External Ophthalmomyiasis: A Case Report.Pravera med reveiw2009; 4(3).

7. Tariq S, Muhammad F,Shakeel A. Herpes zoster complicated by myiasis.J Pak Assoc Derma. 2009; 19:182-4.

8. Ijaz L, Rao RQ, Imran A, Mazhar ZS.Case report of ocular myosis. Pak J Ophthalmol 2008; 24 (3):151-3.

9. Khurana S, Biswal M, Bhatti HS, Pandav SS, Gupta A, Chatterjee SS, Lyngdoh WV, Malla N. Ophthalmomyiasis: Three cases from North India. Indian J Med Microbiol 2010;28:257-61.

10. James D, Ben C,Tim H, Halabi YS,Pieter VT, Steve W, Justin T, and David RW. An outbreak of human external ophthalmomyiasis due to oestrus ovis in Southern Afghanistan. Clin Infect Dis. (2008) 46 (11): e124-e126.z.
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Article Details
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Author:Hanif, Muhammad Kashif; Islam, Qamar ul; Ansari, Uzma
Publication:Pakistan Armed Forces Medical Journal
Article Type:Clinical report
Geographic Code:9PAKI
Date:Jun 30, 2012
Words:881
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